Provider Demographics
NPI:1497363428
Name:HEGWOOD, KATHY (APRN , FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:HEGWOOD
Suffix:
Gender:F
Credentials:APRN , FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 ANGLER DR
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-2152
Mailing Address - Country:US
Mailing Address - Phone:601-799-5572
Mailing Address - Fax:
Practice Address - Street 1:5009 ANGLER DR
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2152
Practice Address - Country:US
Practice Address - Phone:601-799-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily