Basic Information
| Provider Information | |||||||||
| NPI: | 1134107139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARNOLD | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | CECILIA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | A.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1278 OCEAN SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | OCEAN SPRINGS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395643409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288753606 | ||||||||
| FaxNumber: | 2288753687 | ||||||||
| Practice Location | |||||||||
| Address1: | 1278 OCEAN SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | OCEAN SPRINGS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395643409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288753606 | ||||||||
| FaxNumber: | 2288753687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 08/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | R854239 | MS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2100X | R854239 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 0119791 | 05 | MS | MEDICAID |