Healthcare Provider Details

I. General information

NPI: 1356122030
Provider Name (Legal Business Name): BRITTANY SIMMONS WHOLE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 RUNNELS AVE
LONG BEACH MS
39560-5828
US

IV. Provider business mailing address

102 RUNNELS AVE
LONG BEACH MS
39560-5828
US

V. Phone/Fax

Practice location:
  • Phone: 228-265-9177
  • Fax:
Mailing address:
  • Phone: 228-265-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY SIMMONS
Title or Position: OWNER, REGISTERED DIETITIAN
Credential: RD, LD
Phone: 228-265-9177