Individual
KATELYN MCCLUSKEY LILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2778 HIGHWAY 51 S, SENATOBIA, MS 38668-9403
(662) 560-5966
Mailing address
2778 HIGHWAY 51 S, SENATOBIA, MS 38668-9403
(662) 560-5966
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00605
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA00605
PHYSICIAN ASSISTANT
MS
Enumeration date
10/25/2021
Last updated
10/25/2021
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