Healthcare Provider Details

I. General information

NPI: 1528947645
Provider Name (Legal Business Name): CATHERINE COLEMAN MORDECAI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

622 MACBETH ST
BRANDON MS
39047-6683
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-1963
  • Fax: 601-984-1963
Mailing address:
  • Phone: 662-415-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907750
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: