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General NPI Number Information
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NPI Number | 1558018598
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Entity Type | Individual
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Provider Name | CAROLYN J JIMMERSON
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Gender | Female
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 102 RIVERVIEW DR STE A
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City | FLOWOOD
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State | MS
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Zip | 39232-8908
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Country | US
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Telephone | 601-981-1610
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Fax | 601-366-2887
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Provider Business Mailing Address
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Address Line | 102 RIVERVIEW DR STE A
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City | FLOWOOD
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State | MS
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Zip | 39232-8908
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Country | US
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Telephone | 601-981-1610
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Fax | 601-366-2887
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 868951
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License Number State | MS
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