Individual
KAITLYN JOLENA MCMACKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1124 OAKLEIGH RD, OCEAN SPRINGS, MS 39564-5716
(228) 875-3778
(228) 875-9335
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
(228) 497-7576
(228) 497-8869
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10002621A
IN
363A00000X
Physician Assistant
Primary
PA00439
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005382709
—
MS
Enumeration date
11/27/2018
Last updated
12/30/2022
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