Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R861656 | MS |
NPI | 1003846015 |
---|---|
Provider Name | Kathryn L. Navarro |
First Address | Baltimore, MD 21275-5473 |
Second Address | Jackson, MS 39204-3404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q42693 | (02) | HI |