NPI |
1255931762 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Last Name Legal Name |
DOWNS |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
JENNIFER |
The first name of the provider, if the provider
is an individual. |
Provider Credential Text |
PHARM. D. |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Provider First Line Business Practice Location Address |
300 WALMART CIR |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Business Practice Location Address City Name |
BOONEVILLE |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider Business Practice Location Address State Name |
MS |
The first name of the provider, if the provider
is an individual. |
Provider Business Practice Location Address Postal Code |
388291018 |
The middle name of the provider, if the provider
is an individual. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Provider Business Practice Location Address Telephone Number |
6627286863 |
Other last name by which the provider being identified is or has been known. |
Provider Enumeration Date |
10/26/2020 |
Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only. |
Last Update Date |
10/26/2020 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider Gender Code |
F |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Healthcare Provider Taxonomy Code 1 |
183500000X |
The city name in the location address of the provider being identified. |
Provider License Number 1 |
E09806 |
The State code in the location of the provider
being identified. |
Provider License Number State Code 1 |
MS |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The country code in the location address of the provider being identified. |
Is Sole Proprietor |
Y |
The telephone number associated with the location address of the provider being identified. |
NPI Certification Date |
10/26/2020 |
|