Provider Demographics
NPI:1679258982
Name:JONES, KHESAHN CHARRISSE (BSHCA)
Entity type:Individual
Prefix:
First Name:KHESAHN
Middle Name:CHARRISSE
Last Name:JONES
Suffix:
Gender:F
Credentials:BSHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-3630
Mailing Address - Country:US
Mailing Address - Phone:601-880-9133
Mailing Address - Fax:
Practice Address - Street 1:3513 35TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-3630
Practice Address - Country:US
Practice Address - Phone:601-880-9133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS$$$$$$$$$251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health