Provider Demographics
NPI:1750868691
Name:WALTERS, KATHERINE (CNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:501 MARSHALL ST.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202
Mailing Address - Country:US
Mailing Address - Phone:601-354-0869
Mailing Address - Fax:601-352-6521
Practice Address - Street 1:501 MARSHALL ST.
Practice Address - Street 2:SUITE 400
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202
Practice Address - Country:US
Practice Address - Phone:601-354-0869
Practice Address - Fax:601-352-6521
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902687363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology