Healthcare Provider Details

I. General information

NPI: 1013100676
Provider Name (Legal Business Name): CARI THAWN MACDONALD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2274 HIGHWAY 43 S
PICAYUNE MS
39466-8141
US

IV. Provider business mailing address

2274 HIGHWAY 43 S
PICAYUNE MS
39466-8141
US

V. Phone/Fax

Practice location:
  • Phone: 601-798-3989
  • Fax: 601-798-3964
Mailing address:
  • Phone: 601-798-3989
  • Fax: 601-798-3964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR863177
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP03549
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: