Healthcare Provider Details

I. General information

NPI: 1992669022
Provider Name (Legal Business Name): JAMIE RICHARDSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 BEAUVOIR RD
BILOXI MS
39531-4008
US

IV. Provider business mailing address

259 BEAUVOIR RD
BILOXI MS
39531-4008
US

V. Phone/Fax

Practice location:
  • Phone: 228-207-3355
  • Fax:
Mailing address:
  • Phone: 228-207-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3941
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: