| Doctor Name: | MRS. JACKIE C DYESS |
| NPI Number: | 1003972928 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | C. A. P. M. H. N. P. |
| License Number: | R853574 |
| Business Practice Address: | 3550 Highway 468 West Whitfield, MS - 391930157 |
| Business Phone Number: | 6013518000 |
| Business Fax Number: | 6013518301 |
| Mailing Address: | Po Box 157a, WHITFIELD |
| State: | MS |
| Postal Code: | 391930157 |
| Phone Number: | 6013518000 |
| Fax Number: | 6013518301 |
| NPI Enumeration Date: | 12/28/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | R853574 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |