Provider Demographics
NPI:1861553224
Name:SMITH, KATHRYN A (AUDIOLOGISTS)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:AUDIOLOGISTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-579-3310
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:1605 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3110
Practice Address - Country:US
Practice Address - Phone:601-579-3310
Practice Address - Fax:601-264-0231
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA3087231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02086206Medicaid
MS9574868OtherAETNA
MS4656554OtherCIGNA
MS3151998OtherUNITED HEALTHCARE
MS9574868OtherAETNA