Healthcare Provider Details

I. General information

NPI: 1669368676
Provider Name (Legal Business Name): KATHLEEN GUEDON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 SGT PRENTISS DR STE 301
NATCHEZ MS
39120-4753
US

IV. Provider business mailing address

46 SGT PRENTISS DR STE 301
NATCHEZ MS
39120-4753
US

V. Phone/Fax

Practice location:
  • Phone: 601-442-4488
  • Fax: 601-445-2247
Mailing address:
  • Phone: 601-442-4488
  • Fax: 601-445-2247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907507
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number907507
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: