Healthcare Provider Details

I. General information

NPI: 1033319389
Provider Name (Legal Business Name): KATHRYN R FARRELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 RIVER BEND PL SUITE C
JACKSON MS
39232-7618
US

IV. Provider business mailing address

5 RIVER BEND PL SUITE C
JACKSON MS
39232-7618
US

V. Phone/Fax

Practice location:
  • Phone: 601-957-7345
  • Fax: 769-251-5429
Mailing address:
  • Phone: 601-957-7345
  • Fax: 769-251-5429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number20182
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: