Cooley, Julie Grissom

Cooley, Julie Grissom is an individual health care provider with primary practice located at 415 S 28Th Ave , Hattiesburg MS 39401-7246. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Cooley, Julie Grissom can be contacted via phone (601) 579-5010.

Contact Information

Primary practice address
415 S 28Th Ave Hattiesburg MS 39401-7246
Phone: (601) 579-5010
Fax: (601) 579-5240
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 859459 Mississippi

Profile Details

NPI number 1538208830
LBN Legal business name Cooley, Julie Grissom
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 5th, 2007
Last updated Sep 13th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538208830 NPPES
Mississippi Other 753068151 MHP
Mississippi Other 753068151017 MHP
Mississippi Other P00274670 MHP
Mississippi MEDICAID 06782894 MHP

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