Healthcare Provider Details

I. General information

NPI: 1902730419
Provider Name (Legal Business Name): KINGDOM KIDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 HIGHWAY 39 N
MERIDIAN MS
39305-9113
US

IV. Provider business mailing address

2198A HIGHWAY 19 S
MERIDIAN MS
39301-8214
US

V. Phone/Fax

Practice location:
  • Phone: 601-938-7740
  • Fax: 570-886-9161
Mailing address:
  • Phone: 601-938-7740
  • Fax: 570-886-9161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA PRINCELL
Title or Position: OWNER
Credential: OTD, OTR/L
Phone: 601-938-7740