Healthcare Provider Details

I. General information

NPI: 1346968476
Provider Name (Legal Business Name): CALLIE KEIUNA MCNEIL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CIRCLE J DR STE 1
LAUREL MS
39440-1981
US

IV. Provider business mailing address

30 CIRCLE J DR STE 1
LAUREL MS
39440-1981
US

V. Phone/Fax

Practice location:
  • Phone: 601-425-0092
  • Fax: 601-425-0473
Mailing address:
  • Phone: 601-425-0092
  • Fax: 601-425-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number906061
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number906061
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: