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NPI Code Detail

MEDICARE: MRS. JESSICA MICHELLE CAMPBELL

MEDICARE: MRS. JESSICA MICHELLE CAMPBELL
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1770921306
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA MICHELLE CAMPBELL
Provider Business Mailing Address
First Line : 9516 LIVE OAK AVE
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-8549
Country : US
Telephone Number : 817-291-7086
Fax Number :
Provider Business Practice Location Address
First Line : 807 HOLCOMB BLVD
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-3943
Country : US
Telephone Number : 817-291-7086
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2013
Last Update Date : 06/05/2013

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Directions to “ MRS. JESSICA MICHELLE CAMPBELL ” Practice Location

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