Healthcare Provider Details

I. General information

NPI: 1538096268
Provider Name (Legal Business Name): HERBAN SKIN BAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 FLYNT DR STE 428
FLOWOOD MS
39232-9736
US

IV. Provider business mailing address

1084 FLYNT DR STE 428
FLOWOOD MS
39232-9736
US

V. Phone/Fax

Practice location:
  • Phone: 601-503-6494
  • Fax:
Mailing address:
  • Phone: 601-503-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: JASMINE DODD
Title or Position: OWNER
Credential:
Phone: 601-503-6494