Healthcare Provider Details

I. General information

NPI: 1306449301
Provider Name (Legal Business Name): JAZZMEN BRISCOE LMT #2540
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 CLINTON BLVD STE C
CLINTON MS
39056-5251
US

IV. Provider business mailing address

PO BOX 82
CLINTON MS
39060-0082
US

V. Phone/Fax

Practice location:
  • Phone: 601-526-1444
  • Fax:
Mailing address:
  • Phone: 601-526-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2540
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: