Healthcare Provider Details

I. General information

NPI: 1992625644
Provider Name (Legal Business Name): KATHERINE ADAMS ST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 MOORE RD
RED BANKS MS
38661-9121
US

IV. Provider business mailing address

1949 MOORE RD
RED BANKS MS
38661-9121
US

V. Phone/Fax

Practice location:
  • Phone: 662-469-2906
  • Fax:
Mailing address:
  • Phone: 662-469-2906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS4938
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: