Individual
KASSIA ELLEN MCDANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP-BC
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-1470
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-1470
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R877632
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01687283
—
MS
Enumeration date
09/23/2013
Last updated
02/24/2017
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