MEDICARE: DOROTHY HOLMES JUMPIERE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	902916	MS

General Provider Information

NPI Number	:	1578128336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY HOLMES JUMPIERE

Provider Business Mailing Address
First Line	:	6 LAZY MDW
Second Line	:
City	:	CARRIERE
State	:	MS
Zip	:	39426-8196
Country	:	US
Telephone Number	:	228-363-1502
Fax Number	:	601-798-4588

Provider Business Practice Location Address
First Line	:	1514 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3006
Country	:	US
Telephone Number	:	228-382-9222
Fax Number	:	228-382-9224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	06/11/2019

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