Provider Demographics
NPI:1376180992
Name:ELDRIDGE, CATHERINE (FNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 WAYNE ELDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DE KALB
Mailing Address - State:MS
Mailing Address - Zip Code:39328-8011
Mailing Address - Country:US
Mailing Address - Phone:601-917-6979
Mailing Address - Fax:
Practice Address - Street 1:100 WILBURN WAY
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3692
Practice Address - Country:US
Practice Address - Phone:662-498-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily