Provider Demographics
NPI:1649603481
Name:WINN, JAMIE SUZETTE
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:SUZETTE
Last Name:WINN
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 1:151 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAFE
Mailing Address - State:AR
Mailing Address - Zip Code:72436-9781
Mailing Address - Country:US
Mailing Address - Phone:870-240-0444
Mailing Address - Fax:870-240-0466
Practice Address - Street 1:6263 HIGHWAY 49 SOUTH
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450
Practice Address - Country:US
Practice Address - Phone:870-240-0444
Practice Address - Fax:870-240-0466
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator