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
StateLicense IDTaxonomies
MS29076207RR0500X
390200000X
MST-3656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program