Provider Demographics
NPI:1871219071
Name:MCNEIL, ABBY GRACE
Entity type:Individual
Prefix:MISS
First Name:ABBY
Middle Name:GRACE
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 COUNTY ROAD 2343
Mailing Address - Street 2:
Mailing Address - City:LOUIN
Mailing Address - State:MS
Mailing Address - Zip Code:39338-3316
Mailing Address - Country:US
Mailing Address - Phone:601-498-0357
Mailing Address - Fax:
Practice Address - Street 1:129 COUNTY ROAD 2343
Practice Address - Street 2:
Practice Address - City:LOUIN
Practice Address - State:MS
Practice Address - Zip Code:39338-3316
Practice Address - Country:US
Practice Address - Phone:601-498-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program