Provider Demographics
NPI: | 1457849721 |
---|---|
Name: | CHOW, KAITLYN RENFROW (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | KAITLYN |
Middle Name: | RENFROW |
Last Name: | CHOW |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | KAITLYN |
Other - Middle Name: | NICOLE |
Other - Last Name: | RENFROW |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 401 BAPTIST DR STE 401 |
Mailing Address - Street 2: | |
Mailing Address - City: | MADISON |
Mailing Address - State: | MS |
Mailing Address - Zip Code: | 39110-2012 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 601-973-1517 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 401 BAPTIST DR STE 401 |
Practice Address - Street 2: | |
Practice Address - City: | MADISON |
Practice Address - State: | MS |
Practice Address - Zip Code: | 39110-2012 |
Practice Address - Country: | US |
Practice Address - Phone: | 601-973-1517 |
Practice Address - Fax: | 601-973-1623 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-04-23 |
Last Update Date: | 2023-06-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MS | 29076 | 207RR0500X |
390200000X | ||
MS | T-3656 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |