Provider Demographics
NPI:1871464040
Name:KOON, JESSICA PATTERSON
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:PATTERSON
Last Name:KOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 BIRMINGHAM RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-6819
Mailing Address - Country:US
Mailing Address - Phone:662-377-5199
Mailing Address - Fax:
Practice Address - Street 1:1663 BIRMINGHAM RIDGE RD
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-6819
Practice Address - Country:US
Practice Address - Phone:662-377-5199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2025046474363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner