MEDICARE: CHERMAINE MCINNIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224P00000X	Prosthetist	1258752	MS

General Provider Information

NPI Number	:	1053259770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERMAINE MCINNIS

Provider Business Mailing Address
First Line	:	15051 PARKWOOD DR N
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39503-2557
Country	:	US
Telephone Number	:	228-760-0203
Fax Number	:

Provider Business Practice Location Address
First Line	:	15051 PARKWOOD DR N
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39503-2557
Country	:	US
Telephone Number	:	228-760-0203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ CHERMAINE MCINNIS ” Practice Location

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