MEDICARE: KIMBERLY ELAINE DUNN

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	363LF0000X	Family Nurse Practitioner	902410	MS

General Provider Information

NPI Number	:	1437614187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ELAINE DUNN

Provider Business Mailing Address
First Line	:	127 ANITA DR
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39401-8411
Country	:	US
Telephone Number	:	601-336-7197
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 WILLOW PT STE 40
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-1150
Country	:	US
Telephone Number	:	601-336-7153
Fax Number	:	601-336-7254

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

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	02/06/2019

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Directions to “ KIMBERLY ELAINE DUNN ” Practice Location

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