MEDICARE: ROSALYN ROXAN SIMS

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	2255A2300X	Athletic Trainer		MS

General Provider Information

NPI Number	:	1588691208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALYN ROXAN SIMS

Provider Business Mailing Address
First Line	:	1209 E OLD PASS RD
Second Line	:
City	:	LONG BEACH
State	:	MS
Zip	:	39560-5021
Country	:	US
Telephone Number	:	228-596-4249
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 E OLD PASS RD
Second Line	:
City	:	LONG BEACH
State	:	MS
Zip	:	39560-5021
Country	:	US
Telephone Number	:	228-596-4249
Fax Number	:

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	07/08/2007

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