Healthcare Provider Details

I. General information

NPI: 1871300038
Provider Name (Legal Business Name): KKARES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HIGHWAY 39 N
MERIDIAN MS
39301-1021
US

IV. Provider business mailing address

11115 HILL THOMPSON RD
COLLINSVILLE MS
39325-9313
US

V. Phone/Fax

Practice location:
  • Phone: 601-678-1065
  • Fax:
Mailing address:
  • Phone: 601-678-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN THAMES
Title or Position: OWNER
Credential: NP
Phone: 601-480-3986