Provider Demographics
NPI:1649155847
Name:MCCUISTON, KATISHA M (CNA)
Entity type:Individual
Prefix:
First Name:KATISHA
Middle Name:M
Last Name:MCCUISTON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:KATISHA
Other - Middle Name:M
Other - Last Name:MCCUISTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA
Mailing Address - Street 1:513 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:DUCK HILL
Mailing Address - State:MS
Mailing Address - Zip Code:38925-9550
Mailing Address - Country:US
Mailing Address - Phone:662-739-2848
Mailing Address - Fax:
Practice Address - Street 1:513 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:DUCK HILL
Practice Address - State:MS
Practice Address - Zip Code:38925-9550
Practice Address - Country:US
Practice Address - Phone:662-739-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS76459253J00000X, 282E00000X, 253Z00000X, 261QA0600X, 261QV0200X, 3747P1801X, 376K00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253J00000XAgenciesFoster Care Agency
No282E00000XHospitalsLong Term Care Hospital
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty