Healthcare Provider Details

I. General information

NPI: 1477190668
Provider Name (Legal Business Name): KIMBERLY MCRANEY WATSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 OAKHILL CIR
CLINTON MS
39056-3743
US

IV. Provider business mailing address

907 OAKHILL CIR
CLINTON MS
39056-3743
US

V. Phone/Fax

Practice location:
  • Phone: 601-941-3183
  • Fax:
Mailing address:
  • Phone: 601-941-3183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00418
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: