Healthcare Provider Details

I. General information

NPI: 1750868691
Provider Name (Legal Business Name): KATHERINE WALTERS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE BROWN CNP

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARSHALL ST. SUITE 400
JACKSON MS
39202
US

IV. Provider business mailing address

501 MARSHALL ST. SUITE 400
JACKSON MS
39202
US

V. Phone/Fax

Practice location:
  • Phone: 601-354-0869
  • Fax: 601-352-6521
Mailing address:
  • Phone: 601-354-0869
  • Fax: 601-352-6521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number902687
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: