MEDICARE: KIA DUKES OMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1023808318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIA DUKES OMT

Provider Business Mailing Address
First Line	:	PO BOX 162
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-0162
Country	:	US
Telephone Number	:	662-507-5990
Fax Number	:

Provider Business Practice Location Address
First Line	:	881 COUNTY ROAD 115
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-9519
Country	:	US
Telephone Number	:	662-507-5990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2025
Last Update Date	:	05/09/2025

Similar Medicare Providers

1215870316 — AMY BAILEY PTA005049
Practice Location Address:

4986 JOHNSTOWN RD
NEW ALBANY, OH
43054-9519

Practice Phone: 614-384-0800
Practice Fax:

1841684610 — CCHS INC-JOHNSTOWN
Practice Location Address:

5006 JOHNSTOWN RD
NEW ALBANY, OH
43054-9519

Practice Phone: 614-245-8720
Practice Fax:

1023083052 — MR. DANIEL W MALONEY B.S. IN PHY. THERAPY
Practice Location Address:

736 BROADWAY , 6TH FLOOR
NEW YORK, NY
10003-9519

Practice Phone: 212-982-2054
Practice Fax: 212-473-6781

1255165262 — EASTERN SCHOLARS LLC
Practice Location Address:

736 BROADWAY
NEW YORK, NY
10003-9519

Practice Phone: 212-729-1506
Practice Fax:

1194967349 — DR. SHELLI I COLEMAN DO
Practice Location Address:

216 OXFORD RD
NEW ALBANY, MS
38652-3115

Practice Phone: 662-534-9042
Practice Fax: 662-534-9707

1184565772 — MRS. SARA LYNN DERRICK PMHNP-BC
Practice Location Address:

218 S DENTON RD
NEW ALBANY, MS
38652-2810

Practice Phone: 662-598-8141
Practice Fax:

Directions to “ KIA DUKES OMT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.