Provider Demographics
NPI:1225757123
Name:SHOOK, KATHERINE CORBIN (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CORBIN
Last Name:SHOOK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 POTTS ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-2218
Mailing Address - Country:US
Mailing Address - Phone:662-444-1404
Mailing Address - Fax:
Practice Address - Street 1:171 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-3014
Practice Address - Country:US
Practice Address - Phone:662-655-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905542363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner