=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356122030
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRITTANY SIMMONS WHOLE HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2023
-----------------------------------------------------
Last Update Date | 10/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 RUNNELS AVE
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39560-5828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-265-9177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 RUNNELS AVE
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39560-5828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-265-9177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, REGISTERED DIETITIAN
-----------------------------------------------------
Name | BRITTANY SIMMONS
-----------------------------------------------------
Credential | RD, LD
-----------------------------------------------------
Telephone | 228-265-9177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------