Provider Demographics
NPI:1568015550
Name:QUINN, PRINCESS KATHLEENE (BCCS)
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:KATHLEENE
Last Name:QUINN
Suffix:
Gender:F
Credentials:BCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 HIGHLAND COVE PL
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1523
Mailing Address - Country:US
Mailing Address - Phone:601-291-9058
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGHLAND COLONY PKWY STE 5203
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2079
Practice Address - Country:US
Practice Address - Phone:601-291-9058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS188792174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty