Basic Information
| Provider Information | |||||||||
| NPI: | 1770689630 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CATHEY | ||||||||
| FirstName: | RENE | ||||||||
| MiddleName: | HOOD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BUSBY | ||||||||
| OtherFirstName: | RENE' | ||||||||
| OtherMiddleName: | HOOD | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3003 SHORTCUT RD | ||||||||
| Address2: | |||||||||
| City: | PASCAGOULA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395671810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018473306 | ||||||||
| FaxNumber: | 6017829920 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 DEBUYS RD | ||||||||
| Address2: | |||||||||
| City: | BILOXI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395314402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2282734096 | ||||||||
| FaxNumber: | 2285941765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 10/06/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R855920 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | R855920 | 01 | MS | STATE LICENSE | OTHER | MB1935975 | 01 | MS | DEA | OTHER | 500002318 | 01 | MS | MEDICARE | OTHER | 09014428 | 05 | MS | MEDICAID | 04033292 | 05 | MS | MEDICAID |