Provider Demographics
NPI:1194178475
Name:CATLETTE, BRANTLEY WALLACE (NP)
Entity Type:Individual
Prefix:MR
First Name:BRANTLEY
Middle Name:WALLACE
Last Name:CATLETTE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2686 W OXFORD LOOP STE 125
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5427
Mailing Address - Country:US
Mailing Address - Phone:662-233-9033
Mailing Address - Fax:662-233-9043
Practice Address - Street 1:2686 W OXFORD LOOP STE 125
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5427
Practice Address - Country:US
Practice Address - Phone:662-233-9033
Practice Address - Fax:662-233-9043
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901561363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health