Healthcare Provider Details

I. General information

NPI: 1891260808
Provider Name (Legal Business Name): KIMBERLY MICHELLE PRICE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WSF TATUM DR
HATTIESBURG MS
39401-7700
US

IV. Provider business mailing address

PO BOX 1729
HATTIESBURG MS
39403-1729
US

V. Phone/Fax

Practice location:
  • Phone: 601-450-0805
  • Fax: 601-450-0806
Mailing address:
  • Phone: 601-545-8700
  • Fax: 601-450-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902672
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: