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General NPI Number Information
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NPI Number | 1063370831
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Entity Type | Organization
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Legal Business Name | IMPACTING LIVES LLC
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 2304 JACKSON AVE W STE 101
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City | OXFORD
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State | MS
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Zip | 38655-5624
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Country | US
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Telephone | 662-404-7177
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Fax | 662-769-3839
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Provider Business Mailing Address
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Address Line | 2304 JACKSON AVE W STE 101
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City | OXFORD
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State | MS
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Zip | 38655-5624
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Country | US
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Telephone | 662-404-7177
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Fax | 662-796-3839
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA JEAN VINSON
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Credential | NP
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Telephone | 662-404-7177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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