Healthcare Provider Details

I. General information

NPI: 1275425860
Provider Name (Legal Business Name): MACEY D'NAI RAGON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7580 CLARINGTON CV
SOUTHAVEN MS
38671-5655
US

IV. Provider business mailing address

6077 E PRIMACY PKWY STE 140
MEMPHIS TN
38119-5754
US

V. Phone/Fax

Practice location:
  • Phone: 901-259-1600
  • Fax: 901-259-1698
Mailing address:
  • Phone: 901-725-8347
  • Fax: 901-259-7637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number908646
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: