Healthcare Provider Details

I. General information

NPI: 1558445981
Provider Name (Legal Business Name): WOMENS WELLNESS INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 16TH STREET
MERIDIAN MS
39301-2123
US

IV. Provider business mailing address

2401 16TH STREET
MERIDIAN MS
39301-2123
US

V. Phone/Fax

Practice location:
  • Phone: 601-482-4181
  • Fax:
Mailing address:
  • Phone: 601-482-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR876229
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: URELAINE R SIMON
Title or Position: OWNER/OFFICER
Credential: M.D.
Phone: 601-482-4181