Provider Demographics
NPI:1619104627
Name:SCHNEIDER, KATHRYN EVANS (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:EVANS
Last Name:SCHNEIDER
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 1:2500 N STATE ST
Mailing Address - Street 2:DEPT OF PEDIATRICS
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5200
Mailing Address - Fax:601-815-1872
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPT OF PEDIATRICS
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5200
Practice Address - Fax:601-815-1872
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04425849Medicaid
MS302I371996Medicare PIN
MS04425849Medicaid