Grisham, Jennifer L
Grisham, Jennifer L is an individual health care provider with primary practice located at 1573 Medical Park Cir , Tupelo MS 38801-6580. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Grisham, Jennifer L can be contacted via phone (662) 844-9885.Contact Information
Primary practice address
1573 Medical Park Cir
Tupelo MS 38801-6580
Phone: (662) 844-9885
Fax: (662) 842-1350
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 19348 | Mississippi |
Profile Details
| NPI number | 1952406589 |
|---|---|
| LBN Legal business name | Grisham, Jennifer L |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 14th, 2006 |
| Last updated | Jan 20th, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952406589 | NPPES |
| Mississippi | MEDICAID | 06085766 |
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