Healthcare Provider Details

I. General information

NPI: 1376004150
Provider Name (Legal Business Name): JASMEET KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 S FOURTH ST
MORTON MS
39117-3407
US

IV. Provider business mailing address

PO BOX D
FOREST MS
39074-0558
US

V. Phone/Fax

Practice location:
  • Phone: 601-732-1524
  • Fax:
Mailing address:
  • Phone: 601-469-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30554
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: