Provider Demographics
NPI:1457998965
Name:SPANN, KATIE MAE (APRN PMHNP)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:MAE
Last Name:SPANN
Suffix:
Gender:F
Credentials:APRN PMHNP
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:MAE
Other - Last Name:SPANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN PMHNP
Mailing Address - Street 1:200 CAPITOL ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4026
Mailing Address - Country:US
Mailing Address - Phone:601-925-3205
Mailing Address - Fax:
Practice Address - Street 1:1510 HAWTHORNE PL
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-3911
Practice Address - Country:US
Practice Address - Phone:601-813-5680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903657363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health