Healthcare Provider Details

I. General information

NPI: 1538882717
Provider Name (Legal Business Name): LASONYA NEAL CSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5345 HIGHWAY 18 W
JACKSON MS
39209-9421
US

IV. Provider business mailing address

PO BOX 2305
CLINTON MS
39060-2305
US

V. Phone/Fax

Practice location:
  • Phone: 601-927-0188
  • Fax: 601-292-7998
Mailing address:
  • Phone: 601-927-0188
  • Fax: 601-292-7998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberBC2255
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: