Healthcare Provider Details

I. General information

NPI: 1962716894
Provider Name (Legal Business Name): KATHRYN CLAIBORNE ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN LASHONDA CLAIBORNE FNP

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 W NORTHSIDE DR
JACKSON MS
39213-4454
US

IV. Provider business mailing address

PO BOX 24116
JACKSON MS
39225-4116
US

V. Phone/Fax

Practice location:
  • Phone: 601-364-5142
  • Fax: 601-364-5159
Mailing address:
  • Phone: 601-825-7280
  • Fax: 601-825-8130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR877658
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: