Healthcare Provider Details

I. General information

NPI: 1689101404
Provider Name (Legal Business Name): MARY KATHERINE KATHERINE HOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY KATHERINE KERCE

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET
JACKSON MS
39216-4504
US

IV. Provider business mailing address

2500 NORTH STATE STREET
JACKSON MS
39216-4505
US

V. Phone/Fax

Practice location:
  • Phone: 601-405-4764
  • Fax:
Mailing address:
  • Phone: 601-405-4764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number59789
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30107
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: