Healthcare Provider Details

I. General information

NPI: 1346634805
Provider Name (Legal Business Name): MISS-LOU WELLNESS CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5839 PEAR ORCHARD RD
JACKSON MS
39211-3311
US

IV. Provider business mailing address

5839 PEAR ORCHARD RD
JACKSON MS
39211-3311
US

V. Phone/Fax

Practice location:
  • Phone: 601-487-6894
  • Fax: 601-487-6894
Mailing address:
  • Phone: 601-487-6894
  • Fax: 601-487-6894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MS. GETTY E ISRAEL
Title or Position: EXECUTIVE DIRECTOR
Credential: MPH
Phone: 601-487-6894