Individual provider Active NPI

Christina Holy McRae, DMD

  • General Practice Dentistry
  • Jackson, MS
National Provider Identifier
1720571334
Registry record updated Jun 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3998-18 Issued in MS
Practice address
3000 Old Canton Rd Ste 515
Jackson, MS 39216-4235
Phone
(601) 713-1923
NPI assigned
Jun 8, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 8, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3998-18 MS Primary

Addresses

Primary practice location

3000 Old Canton Rd Ste 515
Jackson, MS 39216-4235

Mailing address

4033 Pinewood Dr
Jackson, MS 39211-6447
Phone (601) 572-1430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
3998-18MSMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528416000000",
    "number": "1720571334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4033 PINEWOOD DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392116447",
            "telephone_number": "601-572-1430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 OLD CANTON RD STE 515",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164235",
            "telephone_number": "601-713-1923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCRAE",
        "first_name": "CHRISTINA",
        "middle_name": "HOLY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-08",
        "last_updated": "2018-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3998-18",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.