Healthcare Provider Details

I. General information

NPI: 1346151024
Provider Name (Legal Business Name): CHRISTIAN DAVID MINOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 KATHERINE DR STE A
FLOWOOD MS
39232-9588
US

IV. Provider business mailing address

2969 CURRAN DR N BLDG A
JACKSON MS
39216-4121
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4162
  • Fax: 888-398-1151
Mailing address:
  • Phone: 601-590-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number908731
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: