Basic Information
| Provider Information | |||||||||
| NPI: | 1669712311 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACOON | ||||||||
| FirstName: | YONETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 RAYMOND RD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392044203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013711700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 RAYMOND RD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392044203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013711700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2013 | ||||||||
| LastUpdateDate: | 02/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA 3829 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.