Provider Demographics
NPI:1013478643
Name:WARDEN, MAKESHIA
Entity Type:Individual
Prefix:
First Name:MAKESHIA
Middle Name:
Last Name:WARDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 PINE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3563
Mailing Address - Country:US
Mailing Address - Phone:769-243-3372
Mailing Address - Fax:
Practice Address - Street 1:655 PINE LN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-3563
Practice Address - Country:US
Practice Address - Phone:769-243-3372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator