Healthcare Provider Details

I. General information

NPI: 1073559100
Provider Name (Legal Business Name): KIMBERLEY HELEN MORINE WARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLEY HELEN MORINE

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST UMMC-DEPARTMENT OF DERMATOLOGY
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-8000
  • Fax:
Mailing address:
  • Phone: 601-815-3374
  • Fax: 601-853-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number21549
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: