Healthcare Provider Details

I. General information

NPI: 1467022939
Provider Name (Legal Business Name): WEATON M MCDANIEL MP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S 5TH ST
COLLINS MS
39428-4147
US

IV. Provider business mailing address

701 S HOLLY AVE
COLLINS MS
39428-3894
US

V. Phone/Fax

Practice location:
  • Phone: 601-765-4414
  • Fax: 601-765-9141
Mailing address:
  • Phone: 601-765-6711
  • Fax: 601-698-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number904710
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904710
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: