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NPI Code Detail

MEDICARE: KATHERINE BROOME TOTTY F.N.P.

MEDICARE: KATHERINE BROOME TOTTY F.N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerR869835MS

General Provider Information

NPI Number : 1164856894
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE BROOME TOTTY F.N.P.
Provider Business Mailing Address
First Line : 113 GREEN GATE XING
Second Line :
City : RIDGELAND
State : MS
Zip : 39157-9454
Country : US
Telephone Number : 601-750-2190
Fax Number :
Provider Business Practice Location Address
First Line : 970 LAKELAND DR STE 61
Second Line :
City : JACKSON
State : MS
Zip : 39216-4682
Country : US
Telephone Number : 601-982-7850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2013
Last Update Date : 01/11/2021

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