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MEDICAL MALL HEALTH SERVICES OF MISSISSIPPI, LLC
NPI 1194083139
Nurse Practitioner - Primary Care in Jackson, MS

Active since April 27, 2012
350 W WOODROW WILSON AVE, SUITE 499A, JACKSON, MS 39213(601) 700-7709(877) 852-6352 Get Directions Write a Review

NPPES record last updated: March 12, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Medical Mall Health Services Of Mississippi, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MEDICAL MALL HEALTH SERVICES OF MISSISSIPPI, LLC (NPI 1194083139) is a healthcare organization registered as a primary care in Jackson, Mississippi and active in the NPI registry since April 2012. The organization lists Timothy P Mcneil, Coo, as its authorized official.

NPPES Registry Identity

NPI1194083139
Entity TypeOrganization
Primary Taxonomy363LP2300X
Legal Business NameMEDICAL MALL HEALTH SERVICES OF MISSISSIPPI, LLC
Location Address350 W WOODROW WILSON AVE, SUITE 499AJackson, MS 39213-7681
Mailing Address350 W Woodrow Wilson Ave., Suite 499aJackson, MS 39213-7681 · (601) 700-7709 · Fax (877) 852-6352
Phone(601) 700-7709
Fax(877) 852-6352
Organization SubpartNo
Authorized OfficialTimothy P McneilCoo · (202) 344-5465
Enumeration DateApril 27, 2012
Last NPPES UpdateMarch 12, 2015
✔ NPI 1194083139 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
350 W WOODROW WILSON AVE, Jackson, MS 39213
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JACKSON STATE UNIVERSITY
Social Worker (Clinical)
350 W WOODROW WILSON AVE
JACKSON, MS 39213
Hinds County (601) 979-1531
DR. EVA MAE HENDERSON M.D.
Pediatrics
350 W WOODROW WILSON AVE
JACKSON, MS 39213
Hinds County (601) 709-5150
WANDA JOHNSON BCFNP
Nurse Practitioner (Family)
350 W WOODROW WILSON AVE, SUITE 411
JACKSON, MS 39213
Hinds County (601) 364-2666
DR. SHEILA KALKA JEFF MD
Family Medicine
350 W WOODROW WILSON AVE, BOX 20
JACKSON, MS 39213
Hinds County (601) 364-2666
TIMOTHY PAUL MCNEILL RN
Registered Nurse
350 W WOODROW WILSON AVE, #499A
JACKSON, MS 39213
Hinds County (601) 500-7709
DR. KANDIS VECHELLE BACKUS PHARMD
Pharmacist (Ambulatory Care)
350 W WOODROW WILSON AVE
JACKSON, MS 39213
Hinds County (601) 815-3272
DR. SRINIVASAN VIJAYAKUMAR M.D.
Radiology (Radiation Oncology)
350 W WOODROW WILSON AVE, SUITE 16
JACKSON, MS 39213
Hinds County (601) 815-6886
STATE OF MISSISSIPPI- UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
350 W WOODROW WILSON AVE, SUITE 479
JACKSON, MS 39213
Hinds County (601) 815-6350

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Medical Mall Health Services Of Mississippi, LLC's NPI number?

The NPI number for Medical Mall Health Services Of Mississippi, LLC is 1194083139. It was assigned to this organization in the NPPES registry on April 27, 2012.

Where is Medical Mall Health Services Of Mississippi, LLC located?

Medical Mall Health Services Of Mississippi, LLC is located at 350 W Woodrow Wilson Ave Suite 499A, Jackson, MS 39213. The listed phone number is (601) 700-7709.

What is Medical Mall Health Services Of Mississippi, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

When was this NPI record last updated?

The NPPES record for Medical Mall Health Services Of Mississippi, LLC was last updated on March 12, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.