Individual
ANGELA B. MCCALLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
360 SIMPSON HIGHWAY 149 STE 370, MAGEE, MS 39111-3843
(601) 849-1530
(601) 849-1535
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 849-1530
(601) 849-1535
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R856059
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07780038
—
MS
01
—
431343AB6F
MEDICARE ST DOM
MS
Enumeration date
07/20/2015
Last updated
04/08/2021
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