Provider Demographics
NPI:1083920987
Name:FRIELDS, KATRINA WATKINS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:WATKINS
Last Name:FRIELDS
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:1154 CROSS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-5777
Mailing Address - Country:US
Mailing Address - Phone:662-840-8010
Mailing Address - Fax:662-840-2656
Practice Address - Street 1:1208 GUY PICKLE RD
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-8212
Practice Address - Country:US
Practice Address - Phone:662-256-3120
Practice Address - Fax:662-256-7092
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR686026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03924050Medicaid