Individual provider Active NPI

Kristen Cox Catledge, D.M.D.

  • General Practice Dentistry
  • Hattiesburg, MS
National Provider Identifier
1164869897
Registry record updated Nov 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3691-13 Issued in MS
Practice address
68 Old Airport Rd
Hattiesburg, MS 39401-8382
Phone
(601) 583-4800
Fax
(601) 584-7769
NPI assigned
Jun 4, 2013
Last updated
Nov 9, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3691-13 MS Primary

Addresses

Primary practice location

68 Old Airport Rd
Hattiesburg, MS 39401-8382

Mailing address

PO Box 1729
Hattiesburg, MS 39403-1729
Phone (601) 545-8700

Other identifiers 1

IdentifierTypeStateIssuer
02681853MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150701002379 MS Order and Referring Only - DentistPractitioner - Dentist 1557673639

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3691-13MSMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447027200000",
    "number": "1164869897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1729",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394031729",
            "telephone_number": "601-545-8700",
            "fax_number": "601-450-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68 OLD AIRPORT RD",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394018382",
            "telephone_number": "601-583-4800",
            "fax_number": "601-584-7769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CATLEDGE",
        "first_name": "KRISTEN",
        "middle_name": "COX",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-04",
        "last_updated": "2015-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3691-13",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02681853",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.