Basic Information
Provider Information | |||||||||
NPI: | 1659599504 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VIGNE | ||||||||
FirstName: | KRISTEN | ||||||||
MiddleName: | MARGARET | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | EISBRENNER | ||||||||
OtherFirstName: | KRISTEN | ||||||||
OtherMiddleName: | MARGARET | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 400 VETERANS AVE | ||||||||
Address2: | DIAGNOSTIC MEDICINE SERVICE (113) | ||||||||
City: | BILOXI | ||||||||
State: | MS | ||||||||
PostalCode: | 395312410 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2285235000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 400 VETERANS AVE | ||||||||
Address2: | DIAGNOSTIC MEDICINE SERVICE (113) | ||||||||
City: | BILOXI | ||||||||
State: | MS | ||||||||
PostalCode: | 395312410 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2285235000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/23/2007 | ||||||||
LastUpdateDate: | 09/21/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 4301079272 | MI | Y |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.