Provider Demographics
NPI:1013100676
Name:MACDONALD, CARI THAWN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CARI
Middle Name:THAWN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2274 HIGHWAY 43 S
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-8141
Mailing Address - Country:US
Mailing Address - Phone:601-798-3989
Mailing Address - Fax:601-798-3964
Practice Address - Street 1:2274 HIGHWAY 43 S
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-8141
Practice Address - Country:US
Practice Address - Phone:601-798-3989
Practice Address - Fax:601-798-3964
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863177363LF0000X
LAAP03549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09226703Medicaid
MS841721808OtherMS PHYSICIAN CARE NETWORK