Healthcare Provider Details

I. General information

NPI: 1932315215
Provider Name (Legal Business Name): LIGHTHOUSE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 TOMMY MUNRO DR SUITE A
BILOXI MS
39532-2134
US

IV. Provider business mailing address

925 TOMMY MUNRO DR SUITE A
BILOXI MS
39532-2134
US

V. Phone/Fax

Practice location:
  • Phone: 228-388-3993
  • Fax: 228-385-9941
Mailing address:
  • Phone: 228-388-3993
  • Fax: 228-385-9941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMS

VIII. Authorized Official

Name: DR. KATHRYN SIGURNJAK
Title or Position: PARTNER
Credential: M.D.
Phone: 228-388-3993