Provider Demographics
NPI:1295884617
Name:MCCALLUM, HANNAH E (ACNP)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:E
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7283
Mailing Address - Country:US
Mailing Address - Phone:601-425-5544
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:415 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7283
Practice Address - Country:US
Practice Address - Phone:601-425-5544
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR821702363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR821702OtherNP MEDICAL LICENSE
MS500001475Medicare Oscar/Certification
MSP55827Medicare UPIN