Healthcare Provider Details

I. General information

NPI: 1063346005
Provider Name (Legal Business Name): JANECIA HERRINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3392 STAMPLEY RD
FAYETTE MS
39069-4719
US

IV. Provider business mailing address

3392 STAMPLEY RD
FAYETTE MS
39069-4719
US

V. Phone/Fax

Practice location:
  • Phone: 601-861-9348
  • Fax:
Mailing address:
  • Phone: 601-861-9348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: