Healthcare Provider Details

I. General information

NPI: 1235580614
Provider Name (Legal Business Name): ANN SKELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-0157
  • Fax: 601-984-5257
Mailing address:
  • Phone: 601-815-0157
  • Fax: 601-984-5257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC7823
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: