Healthcare Provider Details

I. General information

NPI: 1760177133
Provider Name (Legal Business Name): JASMINE SIMONE MCNAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 US-61
VICKSBURG MS
39183
US

IV. Provider business mailing address

2100 US-61
VICKSBURG MS
39183
US

V. Phone/Fax

Practice location:
  • Phone: 601-326-8206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37650
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: