Healthcare Provider Details

I. General information

NPI: 1780104646
Provider Name (Legal Business Name): JAMIE SIMONSON DEAN AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W WOODROW WILSON AVE
JACKSON MS
39213-7681
US

IV. Provider business mailing address

172 CLEARVIEW DR E
MADISON MS
39110-4542
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5615
  • Fax: 601-984-5689
Mailing address:
  • Phone: 601-613-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR885616
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: