Provider Demographics
NPI:1548786932
Name:MCDANIEL, DONALD (NP)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:MCDANIEL
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 1:1121 HWY 98/51
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666
Mailing Address - Country:US
Mailing Address - Phone:601-465-0770
Mailing Address - Fax:601-465-0771
Practice Address - Street 1:1121 HWY 98/51
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666
Practice Address - Country:US
Practice Address - Phone:601-465-0770
Practice Address - Fax:601-465-0771
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS823178853OtherFAMILY MEDICINE