Healthcare Provider Details

I. General information

NPI: 1235220823
Provider Name (Legal Business Name): MARY E MCNEER CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E BAKER ST
INDIANOLA MS
38751-2451
US

IV. Provider business mailing address

122 E BAKER ST
INDIANOLA MS
38751-2451
US

V. Phone/Fax

Practice location:
  • Phone: 662-887-2212
  • Fax: 662-887-1279
Mailing address:
  • Phone: 662-887-2212
  • Fax: 662-887-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR730904
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: