Healthcare Provider Details

I. General information

NPI: 1386990521
Provider Name (Legal Business Name): KATRINA B MCSPADDEN BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 US HIGHWAY 78 E
OXFORD AL
36203-2020
US

IV. Provider business mailing address

6700 WASHINGTON AVE S
EDEN PRAIRIE MN
55344-3405
US

V. Phone/Fax

Practice location:
  • Phone: 256-236-6002
  • Fax:
Mailing address:
  • Phone: 830-285-4216
  • Fax: 512-858-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2248
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2248
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: