Healthcare Provider Details

I. General information

NPI: 1861255614
Provider Name (Legal Business Name): ADDISON HILLHOUSE PASSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 HIGHLAND PARK DR
JACKSON MS
39211-5968
US

IV. Provider business mailing address

1428 HIGHLAND PARK DR
JACKSON MS
39211-5968
US

V. Phone/Fax

Practice location:
  • Phone: 601-497-9190
  • Fax:
Mailing address:
  • Phone: 601-497-9190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907046
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number274416
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: