JEAN PENNINGTON MARKS (NPI# 1376813220) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376813220 |
| Entity Type | Individual |
| Full Name | JEAN PENNINGTON MARKS |
| Credential | GNP-BC |
| Practice Address |
115 W Madison St Bolton MS 39041-3209 |
| Mailing Address |
315 E Center St Canton MS 39046-3803 |
| Practice Telephone | 6018667723 |
| Practice Fax Number | 6018667773 |
| Mailing Telephone | 6018550223 |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2012-01-10 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
R860036 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | LICENSE NUMBER | R860036 | 01 |
| Street Address |
115 W MADISON ST |
| City | BOLTON |
| State | MS |
| Zip Code | 39041-3209 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164660635 | Lisa Byrd Healthcare Inc | Nurse Practitioner | 115 W Madison St, Bolton, MS 39041-3209 | 2009-01-22 |
| 1811370216 | Health Matters, LLC | Clinic/Center | 115 W Madison St, Bolton, MS 39041-3209 | 2015-07-02 |
| 1831453091 | Amy Monett-shamon Thomas | Nurse Practitioner | 115 W Madison St, Bolton, MS 39041-3209 | 2012-07-02 |
| 1649555095 | Lisa Byrd Healthcare Inc | Nurse Practitioner | 115 W Madison St, Bolton, MS 39041-3209 | 2011-10-18 |
| 1902180979 | Mary S. Stewart | Nurse Practitioner | 115 W Madison St, Bolton, MS 39041-3209 | 2011-10-07 |
| 1083852131 | Sara Aileen Knight | Nurse Practitioner | 115 W Madison St, Bolton, MS 39041-3209 | 2009-01-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538322409 | Mississippi Nurse Practitioners Inc | Nurse Practitioner | 115 West Madison St., Bolton, MS 39041 | 2008-07-09 |
| 1760414494 | Central Mississippi Civic Improvement Association | Clinic/Center | 9700 I-20 W. Frontage Road, Jackson, MS 39041 | 2006-07-06 |
| 1073065975 | Alisha White | Non-emergency Medical Transport (VAN) | 1041 Thomas Cox Rd, Bolton, MS 39041-6603 | 2016-10-27 |
| 1801170311 | Bolton Edwards Elementary Middle School | Registered Nurse | 9700 I 20, Bolton, MS 39041-9126 | 2011-10-03 |
| 1548265416 | Nona Faye Owens | Psychologist | 5509 Old Highway 80, Bolton, MS 39041-9191 | 2005-06-16 |
| 1851703961 | Kenyuana M. Beachem | Social Worker | 4232 S Norrell Rd, Bolton, MS 39041-9240 | 2014-05-22 |
| 1902466790 | Robin L Bolton | Counselor | 1159 Joe Johnson Rd, Bolton, MS 39041-9543 | 2019-06-14 |
| 1679598783 | Coleman A. Boyd | General Practice | 1635 N Davis Rd, Bolton, MS 39041-9588 | 2006-07-12 |
| Taxonomy Code | 363LG0600X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Gerontology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902180979 | Mary S. Stewart | Nurse Practitioner | 115 W Madison St, Bolton, MS 39041-3209 | 2011-10-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003443458 | Nicole Sherice Taylor | Nurse Practitioner | 845 South Gloster Street, Tupelo, MS 38801 | 2020-03-25 |
| 1316500887 | Hollie Waldron | Nurse Practitioner | 408 Council Cir Ste C, Tupelo, MS 38801-4949 | 2019-04-19 |
| 1063975621 | Sheila Ann Frederick | Nurse Practitioner | 65 Patton Cemetary Rd, Fulton, MS 38843-9353 | 2019-04-10 |
| 1992263685 | Nadine Theresa James | Nurse Practitioner | 1214 Velma St, Hattiesburg, MS 39402-2751 | 2019-03-12 |
| 1396202396 | Roxane Theresa Moncure | Nurse Practitioner | 919 Rutherford Dr, Jackson, MS 39206-2033 | 2019-02-26 |
| 1750889416 | Katherine Bolden | Nurse Practitioner | 1666 Highway 19 S, Meridian, MS 39301-8209 | 2018-01-29 |
| 1306350129 | Tamika M Broome | Nurse Practitioner | 350 W Woodrow Wilson Ave # 411, Jackson, MS 39213-7681 | 2017-12-01 |
| 1992227177 | Charisma T. Cummings | Nurse Practitioner | 102 Riverview Drive, Suite A, Flowood, MS 39232 | 2017-07-10 |
| 1134589930 | Rebecca L. Cauthen | Nurse Practitioner | 885 Liberty Rd Ste 300, Flowood, MS 39232-9006 | 2016-03-07 |
| 1114399284 | Kristie G Jenkins | Nurse Practitioner | 2908 S Lamar Blvd, Suite 100, Oxford, MS 38655-5354 | 2015-10-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.