Provider Demographics
NPI:1073398541
Name:MCGAUGHY, KANTINA
Entity Type:Individual
Prefix:
First Name:KANTINA
Middle Name:
Last Name:MCGAUGHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 COUNTY ROAD 115
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:MS
Mailing Address - Zip Code:38868-9161
Mailing Address - Country:US
Mailing Address - Phone:662-231-6719
Mailing Address - Fax:
Practice Address - Street 1:248 COUNTY ROAD 115
Practice Address - Street 2:
Practice Address - City:SHANNON
Practice Address - State:MS
Practice Address - Zip Code:38868-9161
Practice Address - Country:US
Practice Address - Phone:662-231-6719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS800832294374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide