Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | DANC-D5HFKH | MS |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | DANC-D5HFKH | MS |
NPI | 1144862863 |
---|---|
Provider Name | Mr. Mark A Dancy |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2019 |
Last Update Date | 14/10/2019 |