Provider Demographics
NPI:1952628398
Name:CAIN, DEEDY HILL (NP-C)
Entity Type:Individual
Prefix:MS
First Name:DEEDY
Middle Name:HILL
Last Name:CAIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:DEEDY
Other - Middle Name:HILL
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-1007
Mailing Address - Country:US
Mailing Address - Phone:601-947-8181
Mailing Address - Fax:601-947-1331
Practice Address - Street 1:92 RATLIFF ST
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-6537
Practice Address - Country:US
Practice Address - Phone:601-947-8181
Practice Address - Fax:601-947-1331
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR870765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR870765OtherMEDICAL LICENSURE
MSF0310091OtherAANP
MS05039016Medicaid