Villacorta, Jennifer May Madrid

Villacorta, Jennifer May Madrid is an individual health care provider with primary practice located at 2500 N State St , Jackson MS 39216-4500. She recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as her primary health care specialty. Villacorta, Jennifer May Madrid can be contacted via phone (601) 984-5706.

Contact Information

Primary practice address
2500 N State St Jackson MS 39216-4500
Phone: (601) 984-5706
Fax: (601) 984-5733
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 24333 Mississippi

Profile Details

NPI number 1215166798
LBN Legal business name Villacorta, Jennifer May Madrid
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2009
Last updated Jan 17th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215166798 NPPES
Mississippi MEDICAID 07674356

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