Healthcare Provider Details

I. General information

NPI: 1376074047
Provider Name (Legal Business Name): KRISTEN B RIMES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 SOUTHERLAND ST
JACKSON MS
39216-4825
US

IV. Provider business mailing address

2624 SOUTHERLAND ST
JACKSON MS
39216-4825
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-4282
  • Fax: 601-366-4287
Mailing address:
  • Phone: 601-366-4282
  • Fax: 601-366-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM5947
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: