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General NPI Number Information
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NPI Number | 1659527414
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Entity Type | Organization
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Legal Business Name | JACKSON PUBLIC SCHOOLS CLAUSELL CLINIC
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 618 S PRESIDENT ST
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City | JACKSON
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State | MS
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Zip | 39201-5601
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Country | US
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Telephone | 601-960-8705
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Fax |
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Provider Business Mailing Address
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Address Line | 3330 HARLEY ST
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City | JACKSON
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State | MS
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Zip | 39209-7239
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Country | US
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Telephone | 601-960-8705
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Fax |
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Authorized Official
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Title or Position | LEAD NURSE
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Name | MRS. TAMMY DARLENE CROCKER
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Credential | R.N.
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Telephone | 601-209-4456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | R557579
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License Number State | MS
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