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Individual

MARY L FEAGANS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5800
(601) 261-3530
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5800
(601) 261-3530

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00165
MS
363AM0700X
Medical Physician Assistant
PA200038
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
05202536
MS
05
1591149
LA
01
302I978316
MEDICARE PTAN
MS
01
3122240
UNITED HEALTHCARE
MS
01
8740773
CIGNA
MS
01
9464394
AETNA
MS
Enumeration date
01/11/2006
Last updated
10/24/2012
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