Healthcare Provider Details

I. General information

NPI: 1558718304
Provider Name (Legal Business Name): TELEHEALTHONE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MEADOWBROOK ROAD
JACKSON MS
39206
US

IV. Provider business mailing address

152 WATFORD PARKWAY SUITE 202
CANTON MS
39046-7900
US

V. Phone/Fax

Practice location:
  • Phone: 601-859-4342
  • Fax: 844-965-9592
Mailing address:
  • Phone: 601-859-4342
  • Fax: 844-965-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTPHER B POWE
Title or Position: CHIEF OPERATING OFFICER
Credential: ACNP-BC, PH.D.
Phone: 601-859-4342