Healthcare Provider Details

I. General information

NPI: 1184275133
Provider Name (Legal Business Name): KATHRYN MEREDITH JAMES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 N OAK AVE
RULEVILLE MS
38771
US

IV. Provider business mailing address

840 N OAK AVE
RULEVILLE MS
38771-3227
US

V. Phone/Fax

Practice location:
  • Phone: 662-756-4024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number903569
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: