Healthcare Provider Details

I. General information

NPI: 1659779437
Provider Name (Legal Business Name): ANGELA MCALLISTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 NORTH STATE STREET
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5615
  • Fax: 601-984-5689
Mailing address:
  • Phone: 601-984-5615
  • Fax: 601-984-5689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN001859
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901477
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: