Provider Demographics
NPI:1063073500
Name:HOMES, DOROTHY JEAN
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JEAN
Last Name:HOMES
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:PO BOX 1101
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:MS
Mailing Address - Zip Code:39154-1101
Mailing Address - Country:US
Mailing Address - Phone:601-321-4192
Mailing Address - Fax:
Practice Address - Street 1:1836 FIRST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-6345
Practice Address - Country:US
Practice Address - Phone:601-321-4192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care