Healthcare Provider Details

I. General information

NPI: 1114440187
Provider Name (Legal Business Name): MS. JENNIFER MARIE SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W GOVERNMENT ST STE 101
BRANDON MS
39042-3196
US

IV. Provider business mailing address

PO BOX 17167
HATTIESBURG MS
39404-7167
US

V. Phone/Fax

Practice location:
  • Phone: 601-824-0570
  • Fax: 601-824-0490
Mailing address:
  • Phone: 601-261-5995
  • Fax: 601-261-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA0639
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: