Provider Demographics
NPI:1518164490
Name:MCMULLAN, KATHRYN LINDSEY (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LINDSEY
Last Name:MCMULLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MILLSAPS DR STE C
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1587
Mailing Address - Country:US
Mailing Address - Phone:601-268-5051
Mailing Address - Fax:601-268-5054
Practice Address - Street 1:109 MILLSAPS DR STE C
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-268-5051
Practice Address - Fax:601-268-5054
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20427207R00000X, 207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09605797Medicaid
MS09605797Medicaid
MS302I036919Medicare PIN