Provider Demographics
NPI:1326106915
Name:MCQUIRTER, ALLISON WYNNE (CFNP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:WYNNE
Last Name:MCQUIRTER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1051 HIGHLAND COLONY PKWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8843
Mailing Address - Country:US
Mailing Address - Phone:601-707-3737
Mailing Address - Fax:601-853-2299
Practice Address - Street 1:1051 HIGHLAND COLONY PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8843
Practice Address - Country:US
Practice Address - Phone:601-707-3737
Practice Address - Fax:601-853-2299
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR850880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124725Medicaid
P43297Medicare UPIN