Provider Demographics
NPI:1043391436
Name:THE DIABETES CENTER, PLLC
Entity Type:Organization
Organization Name:THE DIABETES CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:228-875-3606
Mailing Address - Street 1:3099 BIENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-4308
Mailing Address - Country:US
Mailing Address - Phone:228-875-3606
Mailing Address - Fax:228-875-3687
Practice Address - Street 1:1278 OCEAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3409
Practice Address - Country:US
Practice Address - Phone:228-875-3606
Practice Address - Fax:228-875-3687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR854239363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01850731Medicaid
MS01850731Medicaid
MSC03412Medicare ID - Type Unspecified