Provider Demographics
NPI:1467842476
Name:MCDANIEL, ALICIA MICHELLE (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:MICHELLE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14209 COOK RD SUITE 200
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532
Mailing Address - Country:US
Mailing Address - Phone:228-575-2536
Mailing Address - Fax:228-872-0553
Practice Address - Street 1:14209 COOK RD SUITE 200
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532
Practice Address - Country:US
Practice Address - Phone:228-575-2536
Practice Address - Fax:228-872-0553
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS885411363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner