Provider Demographics
NPI:1316569742
Name:MCNAIR, MONIECA MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:MONIECA
Middle Name:MICHELLE
Last Name:MCNAIR
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:PO BOX 68934
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39286-8934
Mailing Address - Country:US
Mailing Address - Phone:601-540-0725
Mailing Address - Fax:769-524-4426
Practice Address - Street 1:635 NAKOMA DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3335
Practice Address - Country:US
Practice Address - Phone:601-540-0725
Practice Address - Fax:759-524-4426
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program