Provider Demographics
NPI:1013357334
Name:ROYALS, KATHERINE O'NEAL (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:O'NEAL
Last Name:ROYALS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-794-8065
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:15 ORLEANS DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8675
Practice Address - Country:US
Practice Address - Phone:601-579-5050
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS24377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03957766Medicaid