Provider Demographics
NPI:1992464648
Name:UPTON, MACY RENEE (NP)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:RENEE
Last Name:UPTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MACY
Other - Middle Name:RENEE
Other - Last Name:AUCOIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:215 KATHERINE DR STE A
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9588
Mailing Address - Country:US
Mailing Address - Phone:601-665-4162
Mailing Address - Fax:888-398-1151
Practice Address - Street 1:550 MOCKINGBIRD CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-7363
Practice Address - Country:US
Practice Address - Phone:985-860-2087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA146975163W00000X
MS905168363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse