Provider Demographics
NPI:1861108268
Name:SIMS, CHRISTINE JENKINS
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JENKINS
Last Name:SIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:BASSFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39421-0143
Mailing Address - Country:US
Mailing Address - Phone:601-674-2642
Mailing Address - Fax:
Practice Address - Street 1:155 HAYNES GRAY RD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:MS
Practice Address - Zip Code:39427-6397
Practice Address - Country:US
Practice Address - Phone:601-674-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS172A00000X
MS800841400347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No172A00000XOther Service ProvidersDriver