Healthcare Provider Details

I. General information

NPI: 1134107139
Provider Name (Legal Business Name): KATHLEEN CECILIA ARNOLD A.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 OCEAN SPRINGS RD
OCEAN SPRINGS MS
39564-3409
US

IV. Provider business mailing address

1278 OCEAN SPRINGS RD
OCEAN SPRINGS MS
39564-3409
US

V. Phone/Fax

Practice location:
  • Phone: 228-875-3606
  • Fax: 228-875-3687
Mailing address:
  • Phone: 228-875-3606
  • Fax: 228-875-3687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR854239
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR854239
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: