Provider Demographics
NPI:1992019285
Name:PLUMMER, JARED (ATC)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:PLUMMER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 EAGLES NEST LN
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5990
Mailing Address - Country:US
Mailing Address - Phone:662-816-6575
Mailing Address - Fax:662-915-1833
Practice Address - Street 1:210 EAGLES NEST LN
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5990
Practice Address - Country:US
Practice Address - Phone:662-816-6575
Practice Address - Fax:662-915-1833
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT05152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer