Provider Demographics
NPI:1366030413
Name:MCALLISTER, RACHAEL ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ELIZABETH
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RACHAEEL
Other - Middle Name:ELIZABETH
Other - Last Name:BOSARGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14173 SADDIE ST
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-8385
Mailing Address - Country:US
Mailing Address - Phone:228-861-5953
Mailing Address - Fax:
Practice Address - Street 1:14173 SADDIE ST
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-8385
Practice Address - Country:US
Practice Address - Phone:228-861-5953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS872163163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse