Healthcare Provider Details

I. General information

NPI: 1104210657
Provider Name (Legal Business Name): LORRINE MAYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 6463
JACKSON MS
39282
US

IV. Provider business mailing address

PO BOX 6463
JACKSON MS
39282
US

V. Phone/Fax

Practice location:
  • Phone: 601-213-9424
  • Fax:
Mailing address:
  • Phone: 601-213-9424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: