Provider Demographics
NPI:1538287479
Name:GADDY, KATHRINE IONE (CWHNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRINE
Middle Name:IONE
Last Name:GADDY
Suffix:
Gender:F
Credentials:CWHNP
Other - Prefix:MRS
Other - First Name:KATHRINE
Other - Middle Name:IONE
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CWHNP
Mailing Address - Street 1:4502 OLD PASS RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501
Mailing Address - Country:US
Mailing Address - Phone:228-863-9977
Mailing Address - Fax:228-863-9912
Practice Address - Street 1:4502 OLD PASS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501
Practice Address - Country:US
Practice Address - Phone:228-863-9977
Practice Address - Fax:228-863-9912
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR871656363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02304794Medicaid
MS500021485Medicare UPIN