Healthcare Provider Details

I. General information

NPI: 1619578176
Provider Name (Legal Business Name): BRIAN ROBERT KUHN NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

786 LAKE HARBOUR DR
RIDGELAND MS
39157-4303
US

IV. Provider business mailing address

1107 HIGHLAND COLONY PKWY STE 219
RIDGELAND MS
39157-6079
US

V. Phone/Fax

Practice location:
  • Phone: 601-499-0022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904262
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: