MEDICARE: MS. KATRINA ANNE MCLEOD MHPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1306858907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATRINA ANNE MCLEOD MHPP

Provider Business Mailing Address
First Line	:	PO BOX 6430
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72766-6430
Country	:	US
Telephone Number	:	479-750-2020
Fax Number	:	479-872-2441

Provider Business Practice Location Address
First Line	:	701 PHILLIPS PL
Second Line	:	SUITE 1
City	:	HUNTSVILLE
State	:	AR
Zip	:	72740-6266
Country	:	US
Telephone Number	:	479-750-2020
Fax Number	:	479-872-2441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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