Provider Demographics
NPI:1477594851
Name:LANTRIP, DANNY DEREK (NP)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:DEREK
Last Name:LANTRIP
Suffix:
Gender:M
Credentials:NP
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 432
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-0432
Mailing Address - Country:US
Mailing Address - Phone:662-456-2800
Mailing Address - Fax:662-456-1715
Practice Address - Street 1:1002 E MADISON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-2417
Practice Address - Country:US
Practice Address - Phone:662-456-2800
Practice Address - Fax:662-456-1715
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853593363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125197Medicaid
MSP00227071OtherRAILROAD MEDICARE
MSP00227071OtherRAILROAD MEDICARE