MEDICAL MALL HEALTH SERVICES OF MISSISSIPPI, LLC (NPI# 1194083139) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194083139 |
| Entity Type | Organization |
| Organization Name | MEDICAL MALL HEALTH SERVICES OF MISSISSIPPI, LLC |
| Practice Address |
350 W Woodrow Wilson Ave Suite 499a Jackson MS 39213-7681 |
| Mailing Address |
350 W Woodrow Wilson Ave. Suite 499a Jackson MS 39213-7681 |
| Practice Telephone | 6017007709 |
| Practice Fax Number | 8778526352 |
| Mailing Telephone | 6017007709 |
| Mailing Fax Number | 8778526352 |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2015-03-12 |
| Authorized Official Name | MR. TIMOTHY P MCNEIL (COO) |
| Authorized Official Telephone | 2023445465 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
350 W WOODROW WILSON AVE SUITE 499A |
| City | JACKSON |
| State | MS |
| Zip Code | 39213-7681 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184607210 | Srinivasan Vijayakumar | Radiology | 350 W Woodrow Wilson Ave, Suite 16, Jackson, MS 39213-7681 | 2005-11-22 |
| 1487285268 | Andreina Guedez Mijares | Dietitian, Registered | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2020-01-30 |
| 1114492725 | Kandis Vechelle Backus | Pharmacist | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2018-10-10 |
| 1780104646 | Jamie Simonson Dean | Nurse Practitioner | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2017-06-22 |
| 1730610775 | Take Care Pharmacy | Pharmacy | 350 W Woodrow Wilson Ave, Suite 311, Jackson, MS 39213-7681 | 2017-03-22 |
| 1891236725 | Christina Purviance | Nurse Practitioner | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2017-03-11 |
| 1265983316 | Molly Sullivan | Nurse Practitioner | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2016-10-24 |
| 1982057345 | Flora K. Green | Nurse Practitioner | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2016-07-20 |
| 1619346822 | Shundra Wilson | Nurse Practitioner | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2015-09-17 |
| 1336521343 | Karen Cathey | Counselor | 350 W Woodrow Wilson Ave, Suite 3572, Jackson, MS 39213-7681 | 2015-06-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679117980 | Cynthia Bailey | Technician | 916 Carnation Street, Jackson, MS 39213 | 2019-10-30 |
| 1871136374 | Shirley Collins Williams | Technician | 3132 Sage St, Jackson, MS 39213 | 2019-10-28 |
| 1275057069 | Nikita Patel | Pharmacist | 830 West Woodrow Wilson Avenue, Jackson, MS 39213 | 2017-08-02 |
| 1346782893 | Mississippi Smiles Dentistry LLC | Dentist | 310 W Woodrow Wilson Ave, 400, Jackson, MS 39213 | 2016-11-15 |
| 1730637521 | Ms Eyecare Associates of Jackson, Pllc. | Optometrist | 310 West Woodrow Wilson Avenue Suite 300, Jackson, MS 39213 | 2016-09-21 |
| 1518410778 | Assurance Home Health Services, LLC | Health Maintenance Organization | 1771 Hamilton Blvd., Jackson, MS 39213 | 2016-07-25 |
| 1831576180 | Dorothy Jeffries Anderson | Counselor | 350 Woodrow Wilson Ave, Jackson, MS 39213 | 2015-05-06 |
| 1740697275 | Sincere Home Care LLC. | Chore Provider | 5911 Holmes Ct, Jackson, MS 39213 | 2014-07-16 |
| 1629401088 | Deborah Diane Wright | Assisted Living Facility | 5911 Holmes Court, Jackson, MS 39213 | 2013-08-20 |
| 1245663251 | Methodist Home Road Living Center | Licensed Practical Nurse | 4560 Methodist Home Road, Jackson, MS 39213 | 2013-08-13 |
| Find all providers in zip 39213 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952965543 | Sheila Kivali Olira | Nurse Practitioner | 5 Windsong Ct, Jackson, NJ 08527-4081 | 2019-04-29 |
| 1366805608 | Laurie Brown | Nurse Practitioner | 6805 Squaw Creek Rd, Jackson, WY 83001-8888 | 2016-04-04 |
| 1407244171 | Bethesda Health Services, LLC | Nurse Practitioner | 29 N Star Dr Ste D, Jackson, TN 38305-6657 | 2015-01-05 |
| 1245227313 | Susan C Martin | Nurse Practitioner | 1385 S Highland Ave Ste B1, Jackson, TN 38301-7547 | 2005-10-04 |
| 1437766011 | Shannon Rae Smith | Nurse Practitioner | 1102 E Michigan Ave, Jackson, MI 49201-1802 | 2020-09-28 |
| 1275189938 | April Terrain Perry | Nurse Practitioner | 3502 W Northside Dr, Jackson, MS 39213 | 2019-08-16 |
| 1801367073 | Careline Palliative Care LLC | Nurse Practitioner | 113 W Michigan Ave Ste 102, Jackson, MI 49201-1340 | 2018-12-16 |
| 1629578273 | Orlesha Carroll Bishop | Nurse Practitioner | 805 E River Pl, Jackson, MS 39202-3486 | 2018-02-20 |
| 1962901587 | Hannah Foreman Ivison | Nurse Practitioner | 2969 Curran Dr N # 200, Jackson, MS 39216 | 2018-02-09 |
| 1598274623 | Allison Leigh Princiotta | Nurse Practitioner | 2500 N State St, Jackson, MS 39216-4500 | 2017-09-20 |
| Find all providers in JACKSON | ||||
Please comment or provide details below to improve the information on MEDICAL MALL HEALTH SERVICES OF MISSISSIPPI, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.