Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Ivyraine Women's Clinic

Organization Women's Health Nurse Practitioner · NPI 1962166264

Ivyraine Women's Clinic provides Women's Health Nurse Practitioner services in Southaven, Mississippi. Registered with an NPI since 2021.

In the registry since
2021

Practice location Address checks out

3964 Goodman Rd E Ste 131
Southaven, MS 38672-8762
Phone: (662) 856-8440
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Women's Health Nurse Practitioner (primary) Taxonomy 363LW0102X

Record details

NPI number1962166264
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jennifer Fredrickson — Np · (662) 856-8440
NPI enumeratedOctober 24, 2021
Last updated in NPPESDecember 29, 2021
Certification dateDecember 29, 2021
Mailing address3964 Goodman Rd E Ste 131, Southaven, MS 38672-8762

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