Healthcare Provider Details

I. General information

NPI: 1770780918
Provider Name (Legal Business Name): CASEY PATRICK SITTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST DEPARTMENT OF PEDIATRICS
JACKSON MS
39216-4500
US

IV. Provider business mailing address

610 SUMMER PL
FLOWOOD MS
39232-7595
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5200
  • Fax:
Mailing address:
  • Phone: 601-906-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT-2033
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: