Provider Demographics
NPI:1972143626
Name:GANT, JARROD EDWARD (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:JARROD
Middle Name:EDWARD
Last Name:GANT
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 SUMMER PL
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8222
Mailing Address - Country:US
Mailing Address - Phone:601-498-9181
Mailing Address - Fax:
Practice Address - Street 1:82 SUMMER PL
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8222
Practice Address - Country:US
Practice Address - Phone:601-498-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01527052Medicaid