| Doctor Name: | JEAN PENNINGTON MARKS |
| NPI Number: | 1376813220 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | GNP-BC |
| License Number: | R860036 |
| Business Practice Address: | 115 W Madison St Bolton, MS - 390413209 |
| Business Phone Number: | 6018667723 |
| Business Fax Number: | 6018667773 |
| Mailing Address: | 315 E Center St, CANTON |
| State: | MS |
| Postal Code: | 390463803 |
| Phone Number: | 6018550223 |
| Fax Number: | |
| NPI Enumeration Date: | 01/10/2012 |
| NPI Last Update Date: | 01/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | R860036 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |