Provider Demographics
NPI:1811944077
Name:BACON, JOSELYN C (CNM)
Entity type:Individual
Prefix:MS
First Name:JOSELYN
Middle Name:C
Last Name:BACON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:350 WEST WOODROW WILSON BLVD
Mailing Address - Street 2:HINDS COUNTY HEALTH DEPARTMENT
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39215
Mailing Address - Country:US
Mailing Address - Phone:601-364-2666
Mailing Address - Fax:601-364-2659
Practice Address - Street 1:350 W WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7681
Practice Address - Country:US
Practice Address - Phone:601-364-2666
Practice Address - Fax:601-364-2659
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR508381363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05603867Medicaid
MS05603867Medicaid