Provider Demographics
NPI:1619479821
Name:GATES, KATRINA LYNN (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:LYNN
Last Name:GATES
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-1143
Mailing Address - Country:US
Mailing Address - Phone:662-587-0326
Mailing Address - Fax:
Practice Address - Street 1:6027 WALNUT GROVE RD STE 312
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2128
Practice Address - Country:US
Practice Address - Phone:901-681-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-03
Last Update Date:2018-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902438363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care