Provider Demographics
NPI:1134107139
Name:ARNOLD, KATHLEEN CECILIA (ANP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CECILIA
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 OCEAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3409
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR854239363LA2200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0119791Medicaid
MS0119791Medicaid