Provider Demographics
NPI:1295281384
Name:ALLDREAD, JESSICA HEATH (FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HEATH
Last Name:ALLDREAD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1117 SUNSET DR STE 101
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4080
Mailing Address - Country:US
Mailing Address - Phone:662-227-1744
Mailing Address - Fax:662-226-1116
Practice Address - Street 1:1117 SUNSET DR STE 101
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4080
Practice Address - Country:US
Practice Address - Phone:662-227-1744
Practice Address - Fax:662-226-1116
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS891866163W00000X
MS901730363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse