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General NPI Number Information
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NPI Number | 1538096268
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Entity Type | Organization
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Legal Business Name | HERBAN SKIN BAR
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Dates
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Enumeration Date | 05/06/2026
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Last Update Date | 05/06/2026
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Provider Practice Location Address
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Address Line | 1084 FLYNT DR STE 428
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City | FLOWOOD
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State | MS
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Zip | 39232-9736
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Country | US
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Telephone | 601-503-6494
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Fax |
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Provider Business Mailing Address
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Address Line | 1084 FLYNT DR STE 428
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City | FLOWOOD
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State | MS
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Zip | 39232-9736
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Country | US
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Telephone | 601-503-6494
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASMINE DODD
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Credential |
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Telephone | 601-503-6494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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