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NPI Code Detail

MEDICARE: KIMSEY ELISE AGUERO PA-C

MEDICARE: KIMSEY ELISE AGUERO PA-C
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1396568051
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMSEY ELISE AGUERO PA-C
Provider Business Mailing Address
First Line : 114 N LEHMBERG RD
Second Line :
City : COLUMBUS
State : MS
Zip : 39702-5554
Country : US
Telephone Number : 662-239-2955
Fax Number :
Provider Business Practice Location Address
First Line : 114 N LEHMBERG RD
Second Line :
City : COLUMBUS
State : MS
Zip : 39702-5554
Country : US
Telephone Number : 662-329-2955
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2024
Last Update Date : 04/02/2026

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Directions to “ KIMSEY ELISE AGUERO PA-C” Practice Location

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