Healthcare Provider Details

I. General information

NPI: 1063866077
Provider Name (Legal Business Name): SHOWANDA MCKAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E MAIN STREET PLZ
SENATOBIA MS
38668-2227
US

IV. Provider business mailing address

300 E MAIN STREET PLZ
SENATOBIA MS
38668-2227
US

V. Phone/Fax

Practice location:
  • Phone: 662-562-8278
  • Fax: 662-562-8279
Mailing address:
  • Phone: 662-562-8278
  • Fax: 662-562-8279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR885537
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: