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NPI Code Detail

MEDICARE: MRS. KIMANDRIA FUTRAL

MEDICARE: MRS. KIMANDRIA FUTRAL
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
1235Z00000XSpeech-Language PathologistS1040MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659590768
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMANDRIA FUTRAL
Provider Business Mailing Address
First Line : 133 WOODBURY PARK PL
Second Line :
City : MADISON
State : MS
Zip : 39110-8191
Country : US
Telephone Number : 601-605-4878
Fax Number :
Provider Business Practice Location Address
First Line : 1929 SPILLWAY RD STE A
Second Line :
City : BRANDON
State : MS
Zip : 39047-6079
Country : US
Telephone Number : 601-992-5370
Fax Number : 601-992-5370
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2007
Last Update Date : 07/09/2007

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Directions to “ MRS. KIMANDRIA FUTRAL ” Practice Location

Language Start Address Practice Location
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