Healthcare Provider Details

I. General information

NPI: 1285643080
Provider Name (Legal Business Name): KIMBERLY PERSHUN EVANS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON AVE # 119
JACKSON MS
39216-5116
US

IV. Provider business mailing address

1500 E WOODROW WILSON AVE # 119
JACKSON MS
39216-5199
US

V. Phone/Fax

Practice location:
  • Phone: 601-962-4471
  • Fax:
Mailing address:
  • Phone: 601-962-4471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19290
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-27460
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-010117
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberE010117
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: