Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1026 | MS |
N | 152W00000X | Optometrist | S-E60-TA-B79 | AL |
NPI | 1003433467 |
---|---|
Provider Name | Dr. Katherine Elizabeth Edwards |
First Address | Hattiesburg, MS 39401-7101 |
Second Address | Hattiesburg, MS 39401-7101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2020 |
Last Update Date | 23/06/2021 |