Provider Demographics
NPI:1770849580
Name:DUMAL, KATHERINE (NP-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DUMAL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-863-7393
Mailing Address - Fax:228-864-0546
Practice Address - Street 1:4300 W RAILROAD ST
Practice Address - Street 2:STE B
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2568
Practice Address - Country:US
Practice Address - Phone:228-863-7393
Practice Address - Fax:228-864-0546
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR874864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily