Individual ProviderTimothy ConnNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address5003 Hardy St Ste 200, Hattiesburg, MS 39402-1331(601) 261-5700PECOS EnrollmentBased on the most recent information from CMS, provider Timothy Conn is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1366977068Provider TypeIndividualFull NameConn, TimothyGenderMaleSole ProprietorNoEnumeration Date5/1/2017Last Updated4/21/2021Contact InformationPractice LocationPractice Address5003 Hardy St Ste 200, Hattiesburg, MS 39402-1331Phone(601) 261-5700Fax(601) 261-5777Mailing LocationMailing Address5003 Hardy St Ste 200, Hattiesburg, MS 39402-1331Phone(601) 261-5700Fax(601) 261-5777Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense874273MississippiProvider IdentifiersIDDescriptionIssuerID03329291DescriptionMedicaidIssuerUnlistedMississippiID902061DescriptionOtherIssuerNURSE PRACTITIONER LICENSEMississippi