Active NPI
Jeanna Lyn Aultman, D.M.D.
- Dentist
- Sumrall, MS
National Provider Identifier
1326486499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3690-13
- Practice address
- 4556 Highway 589
Sumrall, MS 39482-3979 - Phone
- (601) 758-0150
- Fax
- (601) 758-0149
- NPI assigned
- Jun 11, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3690-13 | MS | Primary |
Addresses
Primary practice location
4556 Highway 589
Sumrall, MS 39482-3979
Mailing address
PO Box 469
Sumrall, MS 39482
Phone (601) 758-0150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3690-13 | MS | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370908800000",
"number": "1326486499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 469",
"city": "SUMRALL",
"state": "MS",
"postal_code": "39482",
"telephone_number": "601-758-0150",
"fax_number": "601-758-0149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4556 HIGHWAY 589",
"city": "SUMRALL",
"state": "MS",
"postal_code": "394823979",
"telephone_number": "601-758-0150",
"fax_number": "601-758-0149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AULTMAN",
"first_name": "JEANNA",
"middle_name": "LYN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-11",
"last_updated": "2013-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MS",
"license": "3690-13",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sumrall, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.