Basic Information
| Provider Information | |||||||||
| NPI: | 1386061778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOLDEVILA | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 S GLOSTER ST STE A | ||||||||
| Address2: | |||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388016548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6627674200 | ||||||||
| FaxNumber: | 6627674204 | ||||||||
| Practice Location | |||||||||
| Address1: | 2778 HIGHWAY 51 S | ||||||||
| Address2: | |||||||||
| City: | SENATOBIA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386689403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6627674200 | ||||||||
| FaxNumber: | 6627674204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2014 | ||||||||
| LastUpdateDate: | 11/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146N00000X | 640662976 | MS | N | Emergency Medical Service Providers | Emergency Medical Technician, Basic | 363L00000X | 895910 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 04800061 | 05 | MS | MEDICAID |