Healthcare Provider Details

I. General information

NPI: 1851448963
Provider Name (Legal Business Name): KIMBERLY PALMER RAY PHD, BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N. WEST ST.
JACKSON MS
39202-1037
US

IV. Provider business mailing address

2001 NORTH WEST ST.
JACKSON MS
39202-1037
US

V. Phone/Fax

Practice location:
  • Phone: 601-709-5526
  • Fax: 601-709-5527
Mailing address:
  • Phone: 601-709-5526
  • Fax: 601-709-5527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-00-00351
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36618
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: