1699226399 NPI number — KIMBERLY F DAVIS NP-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699226399 NPI number — KIMBERLY F DAVIS NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
KIMBERLY
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS
Provider Other First Name:
KIM
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699226399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SHERBORNE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOWOOD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39232-8959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-421-9537
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 FOUNTAINS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39110-6343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
769-300-0700
Provider Business Practice Location Address Fax Number:
601-990-2180
Provider Enumeration Date:
10/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  901603 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 901603 . This is a "APRN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: F06161208 . This is a "NP CERT" identifier . This identifiers is of the category "OTHER".
  • Identifier: R867828 . This is a "RN LICENSE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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