Healthcare Provider Details

I. General information

NPI: 1861691701
Provider Name (Legal Business Name): DANIEL EVAN KOEHLINGER RN, WCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 COUNTY ROAD 302
BURNSVILLE MS
38833-9248
US

IV. Provider business mailing address

246 COUNTY ROAD 302
BURNSVILLE MS
38833-9248
US

V. Phone/Fax

Practice location:
  • Phone: 662-427-9240
  • Fax:
Mailing address:
  • Phone: 662-427-9240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberR857592
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number2050710
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: