Healthcare Provider Details

I. General information

NPI: 1053061424
Provider Name (Legal Business Name): TRAMAIN KAREN KIRKSEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S 11TH AVE
LAUREL MS
39440-4312
US

IV. Provider business mailing address

5105 SHUMATE RD
MERIDIAN MS
39305-1508
US

V. Phone/Fax

Practice location:
  • Phone: 601-425-3033
  • Fax:
Mailing address:
  • Phone: 601-480-9295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number905460
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: