Provider Demographics
NPI:1598252645
Name:ESKRIDGE, CATIECHA L
Entity Type:Individual
Prefix:
First Name:CATIECHA
Middle Name:L
Last Name:ESKRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4237
Mailing Address - Country:US
Mailing Address - Phone:662-417-9102
Mailing Address - Fax:
Practice Address - Street 1:1162 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4237
Practice Address - Country:US
Practice Address - Phone:662-417-9102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-14
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS801849955207N00000X
MS00-564861744P3200X
1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatology