MS. MIRANDA STREET SUDDUTH (NPI# 1962804211) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962804211 |
| Entity Type | Individual |
| Full Name | MS. MIRANDA STREET SUDDUTH |
| Credential | PA-C |
| Practice Address |
1607 Doctors Drive Madison MS 39110 |
| Mailing Address |
82 Moss Woods Dr Madison MS 39110-9161 |
| Practice Telephone | 6019272146 |
| Mailing Telephone | 6019272146 |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2015-05-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA00212 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1607 DOCTORS DRIVE |
| City | MADISON |
| State | MS |
| Zip Code | 39110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134784689 | Therapy South - Gluckstadt LLC | Physical Therapist | 1716 Us 51, Ste N, Madison, MS 39110 | 2019-05-09 |
| 1871054098 | Summit Medical Solutions | Durable Medical Equipment & Medical Supplies | 107 Azalea Street, Madison, MS 39110 | 2019-03-29 |
| 1912488198 | Madison Medical Compounding Pharmacy | Pharmacy | 111 Fountains Blvd. Building B Ste. A, Madison, MS 39110 | 2018-08-24 |
| 1679061469 | Nuvena Vein Clinic | Anesthesiology | 120 Fountains Blvd, Madison, MS 39110 | 2018-04-26 |
| 1467960484 | Brick City Drugs, LLC | Durable Medical Equipment & Medical Supplies | 159 Fountains Blvd, Madison, MS 39110 | 2018-01-11 |
| 1093227589 | Hannah Monk Hawthorne | Counselor | 930 Ebenezer Blvd., Suite D, Madisin, MS 39110 | 2017-10-25 |
| 1548786650 | Kimberly Allen | Pharmacist | 1100 Us- 51, Madison, MS 39110 | 2017-08-21 |
| 1891218186 | Delta Elizabeth Stark | Chiropractor | 1085 Gluckstadt Rd., Bld 300 Ste E, Madison, MS 39110 | 2017-07-19 |
| 1861914848 | Laura Hartlein | Dietitian, Registered | 200 Park Circle Dr. #2, Flowood, MS 39110 | 2017-07-12 |
| 1831620608 | Ona Irby | Occupational Therapist | 105 Munich Dr, Madison, MS 39110 | 2017-03-23 |
| Find all providers in zip 39110 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184944068 | Thomas Harvey Greene IIi | Physician Assistant | 248 Ne Hancock Ave, Madison, FL 32340-2560 | 2010-06-02 |
| 1699001735 | Chad Jamison Gilliam | Physician Assistant | 1230 Slaughter Rd Ste C, Madison, AL 35758-5901 | 2009-10-24 |
| 1679763700 | Tamara A Melone | Physician Assistant | 2802 International Lane, Madison, WI 53708-0017 | 2007-07-25 |
| 1932237138 | Craig Michael Roberts | Physician Assistant | 2631 Chamberlain Ave, Madison, WI 53705-3717 | 2007-03-01 |
| 1639234610 | Sally-ann P Johannsen | Physician Assistant | 717 Hidden Cave Rd, Madison, WI 53717-2755 | 2006-12-27 |
| 1023105467 | Nicole Anna Hanson | Physician Assistant | 1617 Sherman Avenue, Madison, WI 53708-0017 | 2006-10-06 |
| 1730137548 | Renee A Knutson | Physician Assistant | 38 Hidden Hollow Trl, Madison, WI 53717-2501 | 2006-05-04 |
| 1669439329 | Deanna J Nakada | Physician Assistant | 750 University Row, Madison, WI 53705-1311 | 2006-04-27 |
| 1326002213 | Angela K Vitcenda | Physician Assistant | 701 Dane Street, Madison, WI 53713 | 2006-04-17 |
| 1265492888 | Marla Dahlk | Physician Assistant | 3705 Brigham Ave, Madison, WI 53714-1203 | 2006-03-27 |
| Find all providers in MADISON | ||||
Please comment or provide details below to improve the information on MS. MIRANDA STREET SUDDUTH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.