Healthcare Provider Details

I. General information

NPI: 1992464648
Provider Name (Legal Business Name): MACY RENEE UPTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MACY RENEE AUCOIN NP

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 MOCKINGBIRD CIR
BRANDON MS
39047-7363
US

IV. Provider business mailing address

215 KATHERINE DR STE A
FLOWOOD MS
39232-9588
US

V. Phone/Fax

Practice location:
  • Phone: 985-860-2087
  • Fax:
Mailing address:
  • Phone: 601-665-4162
  • Fax: 888-398-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number146975
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number905168
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: