Provider Demographics
NPI:1861536286
Name:MAYFIELD, JOCELYLN A (MPT)
Entity type:Individual
Prefix:MS
First Name:JOCELYLN
Middle Name:A
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:MPT
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 605
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-0605
Mailing Address - Country:US
Mailing Address - Phone:228-818-9164
Mailing Address - Fax:228-181-9167
Practice Address - Street 1:1706 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3073
Practice Address - Country:US
Practice Address - Phone:228-818-9164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08635794Medicaid
MS06406391Medicaid
MSC02911Medicare ID - Type UnspecifiedGROUP NUMBER
MS06406391Medicaid