Provider Demographics
NPI:1962280263
Name:LANDRUM, KATRINA M (PMHNP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:M
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8884 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-9177
Mailing Address - Country:US
Mailing Address - Phone:601-880-9769
Mailing Address - Fax:
Practice Address - Street 1:1054 HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-8205
Practice Address - Country:US
Practice Address - Phone:601-531-3200
Practice Address - Fax:601-531-3107
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS906133363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health