Healthcare Provider Details

I. General information

NPI: 1326522319
Provider Name (Legal Business Name): SAMMY ELIZABETH KRATZER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 HOLLAND AVE STE 103
PHILADELPHIA MS
39350-2180
US

IV. Provider business mailing address

PO BOX 649105
DALLAS TX
75264-9105
US

V. Phone/Fax

Practice location:
  • Phone: 601-482-9224
  • Fax:
Mailing address:
  • Phone: 601-207-7093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902902
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: