Healthcare Provider Details

I. General information

NPI: 1699897280
Provider Name (Legal Business Name): JENNIFER STEWART MIZE AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 PEGRAM DR
TUPELO MS
38801-6322
US

IV. Provider business mailing address

PO BOX 2180
TUPELO MS
38803-2180
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-3583
  • Fax: 662-840-8354
Mailing address:
  • Phone: 662-844-3583
  • Fax: 662-840-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA2377
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: