=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467022939
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WEATON M MCDANIEL MP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2021
-----------------------------------------------------
Last Update Date | 07/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1220 JEFFERSON ST
-----------------------------------------------------
City | LAUREL
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39440-4355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-426-4000
-----------------------------------------------------
Fax | 601-399-6184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 S HOLLY AVE.
-----------------------------------------------------
City | COLLINS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39428-3776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-765-6711
-----------------------------------------------------
Fax | 601-698-0112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 904710
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------