Provider Demographics
NPI:1366749152
Name:FARMER, JERILYN DAWN (NP-C)
Entity type:Individual
Prefix:
First Name:JERILYN
Middle Name:DAWN
Last Name:FARMER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 BIENVILLE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5710
Mailing Address - Country:US
Mailing Address - Phone:228-872-4040
Mailing Address - Fax:228-875-2387
Practice Address - Street 1:3704 BIENVILLE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5710
Practice Address - Country:US
Practice Address - Phone:228-872-4040
Practice Address - Fax:228-875-2387
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR860669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily