Healthcare Provider Details

I. General information

NPI: 1093800997
Provider Name (Legal Business Name): WILLIAM M KIRKSEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S GLOSTER ST
TUPELO MS
38801-4934
US

IV. Provider business mailing address

PO BOX 3079
JACKSON MS
39207-3079
US

V. Phone/Fax

Practice location:
  • Phone: 866-754-3852
  • Fax: 205-313-5245
Mailing address:
  • Phone: 866-754-3852
  • Fax: 205-313-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number12133
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: