Basic Information
Provider Information
NPI: 1023362456
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWN
FirstName: KATHRYN
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1225 N STATE ST
Address2:  
City: JACKSON
State: MS
PostalCode: 392022064
CountryCode: US
TelephoneNumber: 6019683070
FaxNumber: 6019681365
Practice Location
Address1: 1225 N STATE ST
Address2:  
City: JACKSON
State: MS
PostalCode: 392022064
CountryCode: US
TelephoneNumber: 6019683070
FaxNumber: 6019746286
Other Information
ProviderEnumerationDate: 11/07/2012
LastUpdateDate: 11/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102X51157TNN Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
207ZP0102X22429MSY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


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