Healthcare Provider Details

I. General information

NPI: 1871297226
Provider Name (Legal Business Name): KATHERINE HENRY JUSTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1837 COOPER RD STE 110
PICAYUNE MS
39466-2838
US

IV. Provider business mailing address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

V. Phone/Fax

Practice location:
  • Phone: 769-717-5005
  • Fax: 601-749-0249
Mailing address:
  • Phone: 601-264-6000
  • Fax: 601-749-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37038
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: