Provider Demographics
NPI:1710619622
Name:ALRED, KATHRYN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:ALRED
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 ROAD 1498
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-8528
Mailing Address - Country:US
Mailing Address - Phone:662-934-4089
Mailing Address - Fax:
Practice Address - Street 1:1250 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2456
Practice Address - Country:US
Practice Address - Phone:662-298-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905394363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner