Healthcare Provider Details

I. General information

NPI: 1831176940
Provider Name (Legal Business Name): KATHLEEN S PATTERSON PHD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 1ST AVE NE
MAGEE MS
39111-3111
US

IV. Provider business mailing address

PO BOX 215
MAGEE MS
39111-0215
US

V. Phone/Fax

Practice location:
  • Phone: 601-466-8141
  • Fax:
Mailing address:
  • Phone: 601-466-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33-514
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: