Healthcare Provider Details

I. General information

NPI: 1467022939
Provider Name (Legal Business Name): WEATON M MCDANIEL MP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 JEFFERSON ST
LAUREL MS
39440-4355
US

IV. Provider business mailing address

701 S HOLLY AVE.
COLLINS MS
39428-3776
US

V. Phone/Fax

Practice location:
  • Phone: 601-426-4000
  • Fax: 601-399-6184
Mailing address:
  • Phone: 601-765-6711
  • Fax: 601-698-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904710
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: