Individual
KATELYN REBECCA MOFFETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1102 CONSTITUTION AVE, MERIDIAN, MS 39301-4001
(601) 683-3117
(601) 683-2505
Mailing address
1102 CONSTITUTION AVE, MERIDIAN, MS 39301-4001
(601) 703-5600
(601) 703-5691
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R882198
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04584751
—
MS
Enumeration date
02/07/2012
Last updated
10/26/2017
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