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General NPI Number Information
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NPI Number | 1891233276
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Entity Type | Organization
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Legal Business Name | OPTIMUM HEALTHCARE ASSOCIATES, PA
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 11/22/2017
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Provider Practice Location Address
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Address Line | 5350 EXECUTIVE PL SUITE 8
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City | JACKSON
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State | MS
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Zip | 39206-4100
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Country | US
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Telephone | 601-927-1872
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Fax | 949-607-3442
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Provider Business Mailing Address
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Address Line | PO BOX 1906
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City | MADISON
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State | MS
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Zip | 39130-1906
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Country | US
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Telephone | 601-942-8447
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Fax | 949-607-3442
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Authorized Official
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Title or Position | OWNER/CEO/NP
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Name | DR. FELISA DENISE WILSON-SIMPSON
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Credential | PHD, FNP-BC, PNP-BC
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Telephone | 601-397-6236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | R784445
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R784445
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License Number State | MS
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