MEDICARE: ADDISON HILLHOUSE PASSMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	907046	MS
2	163W00000X	Registered Nurse	274416	TN

General Provider Information

NPI Number	:	1861255614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADDISON HILLHOUSE PASSMAN

Provider Business Mailing Address
First Line	:	1428 HIGHLAND PARK DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-5968
Country	:	US
Telephone Number	:	601-497-9190
Fax Number	:

Provider Business Practice Location Address
First Line	:	1428 HIGHLAND PARK DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-5968
Country	:	US
Telephone Number	:	601-497-9190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	12/30/2025

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Directions to “ ADDISON HILLHOUSE PASSMAN ” Practice Location

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