Healthcare Provider Details

I. General information

NPI: 1508400359
Provider Name (Legal Business Name): JILL MILLER CORRADINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VETERANS AVE
BILOXI MS
39531-2410
US

IV. Provider business mailing address

1605 SHELBY LN
OCEAN SPRINGS MS
39564-8775
US

V. Phone/Fax

Practice location:
  • Phone: 228-282-9000
  • Fax:
Mailing address:
  • Phone: 228-282-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC5716
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: