Provider Demographics
NPI:1932440997
Name:PRIDDY, JESSICA ROSS (FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSS
Last Name:PRIDDY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 SUMRALL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-2652
Mailing Address - Country:US
Mailing Address - Phone:601-736-6443
Mailing Address - Fax:601-736-2543
Practice Address - Street 1:912 SUMRALL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-2652
Practice Address - Country:US
Practice Address - Phone:601-736-6443
Practice Address - Fax:601-736-2543
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR875117363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care