Provider Demographics
NPI:1558718304
Name:TELEHEALTHONE, LLC
Entity Type:Organization
Organization Name:TELEHEALTHONE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTPHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:POWE
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP-BC, PHD
Authorized Official - Phone:601-859-4342
Mailing Address - Street 1:152 WATFORD PARKWAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-7900
Mailing Address - Country:US
Mailing Address - Phone:601-859-4342
Mailing Address - Fax:844-965-9592
Practice Address - Street 1:225 MEADOWBROOK ROAD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206
Practice Address - Country:US
Practice Address - Phone:601-859-4342
Practice Address - Fax:844-965-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00525567Medicaid
MS00525567Medicaid