Healthcare Provider Details

I. General information

NPI: 1174626303
Provider Name (Legal Business Name): DANIEL JOSEPH MCKIEVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 22ND AVE STE B
MERIDIAN MS
39301-4016
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 315
MEMPHIS TN
38120-9401
US

V. Phone/Fax

Practice location:
  • Phone: 601-483-0039
  • Fax: 601-485-7240
Mailing address:
  • Phone: 877-348-1281
  • Fax: 901-227-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number13486
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number13486
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: