Provider Demographics
NPI:1871907071
Name:HEARN, TOTSSETA
Entity type:Individual
Prefix:
First Name:TOTSSETA
Middle Name:
Last Name:HEARN
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 1:290 ALMA KIRK RD
Mailing Address - Street 2:
Mailing Address - City:DE KALB
Mailing Address - State:MS
Mailing Address - Zip Code:39328-8144
Mailing Address - Country:US
Mailing Address - Phone:601-575-8932
Mailing Address - Fax:601-743-4173
Practice Address - Street 1:290 ALMA KIRK RD
Practice Address - Street 2:
Practice Address - City:DE KALB
Practice Address - State:MS
Practice Address - Zip Code:39328-8144
Practice Address - Country:US
Practice Address - Phone:601-575-8932
Practice Address - Fax:601-743-4173
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS802061140347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle