Healthcare Provider Details

I. General information

NPI: 1770849580
Provider Name (Legal Business Name): KATHERINE DUMAL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W RAILROAD ST STE B
GULFPORT MS
39501-2568
US

IV. Provider business mailing address

PO BOX 1810
GULFPORT MS
39502-1810
US

V. Phone/Fax

Practice location:
  • Phone: 228-863-7393
  • Fax: 228-864-0546
Mailing address:
  • Phone: 228-863-7393
  • Fax: 228-864-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR874864
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: