Healthcare Provider Details

I. General information

NPI: 1922615293
Provider Name (Legal Business Name): MARIA KATHERINE TOWNSEND FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 OLD HIGHWAY 35
FOREST MS
39074-8816
US

IV. Provider business mailing address

456 OLD HIGHWAY 35
FOREST MS
39074-8816
US

V. Phone/Fax

Practice location:
  • Phone: 601-507-2812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903848
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: