Provider Demographics
NPI:1619596434
Name:BROWN, KATHRYN WEGENER (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:WEGENER
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:KATHRYN
Other - Last Name:WEGENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:862 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1618
Mailing Address - Country:US
Mailing Address - Phone:601-405-9015
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-12
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program