Individual
KATHERINE MICHELLE BRUISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4215 15TH ST, GULFPORT, MS 39501-2523
(228) 863-5211
(228) 863-4101
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 863-5211
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00833
MS
Other
Enumeration date
09/26/2024
Last updated
09/26/2024
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