Provider Demographics
NPI:1649002866
Name:FOXWORTH, JERICA (PMHNP)
Entity type:Individual
Prefix:
First Name:JERICA
Middle Name:
Last Name:FOXWORTH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 STEEP HOLW
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7004
Mailing Address - Country:US
Mailing Address - Phone:601-316-0019
Mailing Address - Fax:
Practice Address - Street 1:148 STEEP HOLW
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7004
Practice Address - Country:US
Practice Address - Phone:601-316-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906799363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health