Healthcare Provider Details

I. General information

NPI: 1184560930
Provider Name (Legal Business Name): XTREME CROWNS CRANIAL PROSTHETICS BY VXBL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 NORTHTOWN DR STE 110
JACKSON MS
39211-3699
US

IV. Provider business mailing address

345 WILLOW WAY
CANTON MS
39046-3137
US

V. Phone/Fax

Practice location:
  • Phone: 769-233-0942
  • Fax:
Mailing address:
  • Phone: 769-233-0942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: FRANSHA L HOLLINS
Title or Position: OWNER
Credential:
Phone: 769-233-0942