Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ivyraine Women's Clinic

Organization Women's Health Nurse Practitioner · NPI 1962166264

Ivyraine Women's Clinic is a Women's Health Nurse Practitioner 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
Show map & directions

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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