Provider Demographics
NPI:1861578635
Name:MASCAGNI, JENNIFER REEDER (CFNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:REEDER
Last Name:MASCAGNI
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-261-3500
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:4210 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3093
Practice Address - Country:US
Practice Address - Phone:601-261-3500
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863841363LF0000X
MS863841363L00000X
LARN109495 APO4933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09025802Medicaid