Individual
KATHERINE PUCKETT GINN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-2637
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(601) 200-2637
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
902808
MS
363LF0000X
Family Nurse Practitioner
902808
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08220070
—
MS
01
—
688710
MEDICARE
MS
01
—
P02359034
RAILROAD MEDICARE
MS
Enumeration date
07/12/2018
Last updated
10/24/2025
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