=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306330253
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATLYN SPRADLING
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2018
-----------------------------------------------------
Last Update Date | 08/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3309 HIGHWAY 371 N
-----------------------------------------------------
City | MANTACHIE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38855-7267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-322-3901
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 96
-----------------------------------------------------
City | MANTACHIE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38855-0096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-282-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | E-15009
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------