Healthcare Provider Details

I. General information

NPI: 1629007406
Provider Name (Legal Business Name): KENT ALAN KIRCHNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E. WOODROW WILSON BLVD
JACKSON MS
39216-5199
US

IV. Provider business mailing address

1500 E. WOODROW WILSON BLVD
JACKSON MS
39216-5199
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-4471
  • Fax: 601-364-1456
Mailing address:
  • Phone: 601-362-4471
  • Fax: 601-364-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number08682
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: