Healthcare Provider Details

I. General information

NPI: 1306632955
Provider Name (Legal Business Name): WILLENA CAUSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N FRONT ST
RICHTON MS
39476-2204
US

IV. Provider business mailing address

153 SCENIC DR
HATTIESBURG MS
39401-8403
US

V. Phone/Fax

Practice location:
  • Phone: 769-369-0010
  • Fax:
Mailing address:
  • Phone: 601-466-8509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number907384
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: