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General NPI Number Information
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NPI Number | 1689129793
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Entity Type | Organization
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Legal Business Name | JACKSON HINDS COMPREHENSIVE HEALTH
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Dates
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Enumeration Date | 08/18/2016
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 1017 BELLWOOD CIR
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City | SUMMIT
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State | MS
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Zip | 39666-7179
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Country | US
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Telephone | 601-248-9195
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 BELLWOOD CIR
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City | SUMMIT
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State | MS
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Zip | 39666-7179
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Country | US
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Telephone | 601-248-9195
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JASMIN CHAPMAN
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Credential |
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Telephone | 601-364-5142
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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 | 901645
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License Number State | MS
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