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General NPI Number Information
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NPI Number | 1780104646
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Entity Type | Individual
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Provider Name | JAMIE SIMONSON DEAN AGACNP
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Gender | Female
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 06/22/2017
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Provider Practice Location Address
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Address Line | 350 W WOODROW WILSON AVE
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City | JACKSON
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State | MS
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Zip | 39213-7681
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Country | US
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Telephone | 601-984-5615
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Fax | 601-984-5689
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Provider Business Mailing Address
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Address Line | 172 CLEARVIEW DR E
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City | MADISON
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State | MS
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Zip | 39110-4542
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Country | US
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Telephone | 601-613-4154
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Fax |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | R885616
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License Number State | MS
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