Provider Demographics
NPI:1033723325
Name:CALLIHAN, EDWARD SCOTT (NP-C)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:SCOTT
Last Name:CALLIHAN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 COLONY PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6638
Mailing Address - Country:US
Mailing Address - Phone:662-571-2689
Mailing Address - Fax:
Practice Address - Street 1:342 GILCHRIST DR
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-6671
Practice Address - Country:US
Practice Address - Phone:601-939-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily