Healthcare Provider Details

I. General information

NPI: 1255698130
Provider Name (Legal Business Name): KAREN DWYER HULETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 LAKESHORE DR
MADISON MS
39110-7115
US

IV. Provider business mailing address

365 LAKESHORE DR
MADISON MS
39110-7115
US

V. Phone/Fax

Practice location:
  • Phone: 601-607-4263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number06880
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: