Provider Demographics
NPI:1083475222
Name:CRIPPS, JAMES DEWAYNE (ATC LAT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DEWAYNE
Last Name:CRIPPS
Suffix:
Gender:M
Credentials:ATC LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7735 HIGHWAY 614
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39562-8249
Mailing Address - Country:US
Mailing Address - Phone:228-218-1479
Mailing Address - Fax:228-588-0273
Practice Address - Street 1:7001 HIGHWAY 614
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39562-6483
Practice Address - Country:US
Practice Address - Phone:228-588-2072
Practice Address - Fax:228-588-0273
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSAT00972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer