Individual
KATELYN STALNAKER RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
499 GLOSTER CREEK VLG STE G1, TUPELO, MS 38801-4751
(662) 377-2663
Mailing address
80 LITTLE CIR, BELDEN, MS 38826-9118
(662) 419-2105
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
897205
MS
363L00000X
Nurse Practitioner
Primary
905648
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
897205
RN LICENSE
MS
01
—
905648
APRN LICENSE
MS
Enumeration date
10/15/2020
Last updated
11/02/2022
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