Provider Demographics
NPI:1780300376
Name:TEMPLETON, JESSICA HARRIS (FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HARRIS
Last Name:TEMPLETON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 E GALLMAN RD
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-9449
Mailing Address - Country:US
Mailing Address - Phone:601-260-3580
Mailing Address - Fax:
Practice Address - Street 1:501 MARSHALL ST STE 104
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1663
Practice Address - Country:US
Practice Address - Phone:601-969-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily