Healthcare Provider Details

I. General information

NPI: 1912909607
Provider Name (Legal Business Name): KATHLEEN CABONI QUINN EDD, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 E SECOND ST
PASS CHRISTIAN MS
39571-4628
US

IV. Provider business mailing address

PO BOX 268
PASS CHRISTIAN MS
39571-0268
US

V. Phone/Fax

Practice location:
  • Phone: 601-467-0041
  • Fax:
Mailing address:
  • Phone: 601-467-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0291
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16462
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number03-06-88
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number668367
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR87655
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: