Basic Information
| Provider Information | |||||||||
| NPI: | 1649647256 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNCAN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | DUNCAN | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherCredential: | NP-C | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1150 S BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | WAVELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395763501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2284930947 | ||||||||
| FaxNumber: | 2285757103 | ||||||||
| Practice Location | |||||||||
| Address1: | 15200 COMMUNITY RD | ||||||||
| Address2: | |||||||||
| City: | GULFPORT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395033085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285757120 | ||||||||
| FaxNumber: | 2285757103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2015 | ||||||||
| LastUpdateDate: | 08/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R860058 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.