Healthcare Provider Details

I. General information

NPI: 1477479384
Provider Name (Legal Business Name): HEAL ALL WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2189 HENRY HILL DR STE B
JACKSON MS
39204-2002
US

IV. Provider business mailing address

2189 HENRY HILL DR STE B
JACKSON MS
39204-2002
US

V. Phone/Fax

Practice location:
  • Phone: 601-351-9875
  • Fax: 888-398-1151
Mailing address:
  • Phone: 601-351-9875
  • Fax: 888-398-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY POYTHRESS
Title or Position: VP OF BILLING & CREDENTIALING
Credential:
Phone: 601-665-4162