Healthcare Provider Details

I. General information

NPI: 1275073157
Provider Name (Legal Business Name): MARTHA PHILLIPS CATLETTE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 PRATT PLACE RD
INVERNESS MS
38753-9574
US

IV. Provider business mailing address

64 PRATT PLACE RD PO BOX 304
INVERNESS MS
38753-9574
US

V. Phone/Fax

Practice location:
  • Phone: 662-207-8595
  • Fax:
Mailing address:
  • Phone: 662-207-8595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number901945
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: