Healthcare Provider Details

I. General information

NPI: 1619599677
Provider Name (Legal Business Name): KAREN JANE DAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN JANE HEWITT

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 BOLING ST
JACKSON MS
39213-4418
US

IV. Provider business mailing address

214 CHERRY BARK DR
BRANDON MS
39047-9552
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-0123
  • Fax:
Mailing address:
  • Phone: 504-913-4258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number688312
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: