Provider Demographics
NPI:1881615573
Name:NUTTER, KATHRYN M (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:M
Last Name:NUTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LEIGH
Other - Last Name:MATHENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54 SGT.S.. PRENTISS DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120
Mailing Address - Country:US
Mailing Address - Phone:601-442-2585
Mailing Address - Fax:601-442-6299
Practice Address - Street 1:54 SERGEANT PRENTISS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4726
Practice Address - Country:US
Practice Address - Phone:601-442-2585
Practice Address - Fax:601-442-6299
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS179662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278948Medicaid
AL009933082Medicaid
MS05683205Medicaid
LA1454249Medicaid
OR278948Medicaid
MS512I300159Medicare PIN
MS05683205Medicaid
LA1454249Medicaid
AL009933082Medicaid