Provider Demographics
NPI:1649871682
Name:KULUZ, KATHERINE RAE (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RAE
Last Name:KULUZ
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:RAE
Other - Last Name:HERNDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:735 BUDDELIA CV
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-4118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3101 DENNY AVE STE 210
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5307
Practice Address - Country:US
Practice Address - Phone:288-095-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant