Provider Demographics
NPI:1801446000
Name:MCNIEL, JOSHUA
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MCNIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOSHUA
Other - Middle Name:
Other - Last Name:MCNIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:4500 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2569
Mailing Address - Country:US
Mailing Address - Phone:228-867-4000
Mailing Address - Fax:
Practice Address - Street 1:4533 13TH ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2516
Practice Address - Country:US
Practice Address - Phone:228-214-9639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00436363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant