Provider Demographics
NPI:1871132076
Name:MCCRAY, MEDDOL REGINA (NP)
Entity type:Individual
Prefix:MRS
First Name:MEDDOL
Middle Name:REGINA
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 30TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-6056
Mailing Address - Country:US
Mailing Address - Phone:228-369-8956
Mailing Address - Fax:
Practice Address - Street 1:2070 30TH ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-6055
Practice Address - Country:US
Practice Address - Phone:228-369-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty