Healthcare Provider Details

I. General information

NPI: 1386844066
Provider Name (Legal Business Name): KIMBERLY JANE MCKAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 HIGHWAY 13 S
MORTON MS
39117-3353
US

IV. Provider business mailing address

PO BOX 2065
MERIDIAN MS
39302-2065
US

V. Phone/Fax

Practice location:
  • Phone: 601-732-6301
  • Fax: 601-732-1062
Mailing address:
  • Phone: 601-703-4282
  • Fax: 601-703-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT-1938
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20926
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: