Provider Demographics
NPI:1497768675
Name:MCCARLEY, CHRISTOPHER K (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:K
Last Name:MCCARLEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7062
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-7062
Mailing Address - Country:US
Mailing Address - Phone:662-377-7170
Mailing Address - Fax:662-377-2423
Practice Address - Street 1:830 S GLOSTER ST
Practice Address - Street 2:NMMC EAST TOWER, 3RD FLOOR
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4934
Practice Address - Country:US
Practice Address - Phone:662-377-7170
Practice Address - Fax:662-377-2423
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA020363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0124633Medicaid
MSP73856Medicare UPIN