Provider Demographics
NPI:1609225770
Name:FLEMMONS, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:FLEMMONS
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 1:900 SHADOW CREEK DR APT 102
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-6250
Mailing Address - Country:US
Mailing Address - Phone:662-234-3039
Mailing Address - Fax:
Practice Address - Street 1:900 SHADOW CREEK DR APT 102
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-6250
Practice Address - Country:US
Practice Address - Phone:662-234-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion