Basic Information
| Provider Information | |||||||||
| NPI: | 1780652362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | JODY | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | CFNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 587 HIGHWAY 51 STE T | ||||||||
| Address2: | |||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391572567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017907711 | ||||||||
| FaxNumber: | 6017907712 | ||||||||
| Practice Location | |||||||||
| Address1: | 728 CLINTON PKWY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CLINTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390565227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012004800 | ||||||||
| FaxNumber: | 6019240473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R688797 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 753068151001 | 01 | MS | TRICARE | OTHER | 00124952 | 05 | MS | MEDICAID | 753068151 | 01 | MS | MS HEALTH PARTNERS | OTHER | 753068151 | 01 | MS | MS PHYSICIANS CARE NETWOR | OTHER | 168390703 | 01 | MS | US DEPT OF LABOR | OTHER | P00062082 | 01 | MS | RR MEDICARE | OTHER |