Individual
DANNY DEREK LANTRIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1002 E MADISON ST, HOUSTON, MS 38851-2417
(662) 456-2800
(662) 456-1715
Mailing address
PO BOX 432, HOUSTON, MS 38851-0432
(662) 456-2800
(662) 456-1715
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R853593
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125197
—
MS
01
—
P00227071
RAILROAD MEDICARE
MS
Enumeration date
06/09/2006
Last updated
11/01/2007
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