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General NPI Number Information
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NPI Number | 1003205238
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Entity Type | Individual
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Provider Name | MICHAEL J MCREYNOLDS CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 2100 HIGHWAY 61 N
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City | VICKSBURG
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State | MS
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Zip | 39183-8211
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Country | US
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Telephone | 601-831-1146
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Fax |
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Provider Business Mailing Address
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Address Line | 127 BRITTON CIR
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City | FLOWOOD
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State | MS
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Zip | 39232-8110
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Country | US
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Telephone | 571-330-1646
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R880370
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License Number State | MS
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