Basic Information
Provider Information
NPI: 1881275113
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCNEER
FirstName: CYNDY
MiddleName: LYNNE
NamePrefix:  
NameSuffix:  
Credential: RDN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 321359
Address2:  
City: FLOWOOD
State: MS
PostalCode: 392321359
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1040 RIVER OAKS DR STE 304
Address2:  
City: FLOWOOD
State: MS
PostalCode: 392329575
CountryCode: US
TelephoneNumber: 6019361170
FaxNumber: 6019335455
Other Information
ProviderEnumerationDate: 04/19/2021
LastUpdateDate: 04/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000XD0589MSY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


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