Provider Demographics
NPI:1568662443
Name:WINTER, MOLLIE KRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:MOLLIE
Middle Name:KRISTINE
Last Name:WINTER
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:MOLLIE
Other - Middle Name:KRISTINE
Other - Last Name:SMITH-SOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10467 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4634
Mailing Address - Country:US
Mailing Address - Phone:228-374-2494
Mailing Address - Fax:
Practice Address - Street 1:23453 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:SAUCIER
Practice Address - State:MS
Practice Address - Zip Code:39574-7521
Practice Address - Country:US
Practice Address - Phone:228-392-4153
Practice Address - Fax:228-832-0657
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21170208000000X
FLME113609208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00302364Medicaid