1710902390 NPI number — DR. KIMBERLY G HARKINS MD

Table of content: DR. KIMBERLY G HARKINS MD (NPI 1710902390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710902390 NPI number — DR. KIMBERLY G HARKINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARKINS
Provider First Name:
KIMBERLY
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARKINS
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1710902390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 N STATE ST
Provider Second Line Business Mailing Address:
CBO-SUITE 4200
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39216-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-496-9794
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 NORTH STATE STREET
Provider Second Line Business Practice Location Address:
DEPARTMENT OF MEDICINE DIVISION OF HYPERTENSION
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-984-6850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2006

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: 207R00000X , with the licence number:  15503 , 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: RR 110217436 . This is a "RAILROAD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: P00462209 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00121807 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1390941 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".