Healthcare Provider Details

I. General information

NPI: 1548357981
Provider Name (Legal Business Name): KIMBERLY L WEBB D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/20/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CENTRAL ST
WATER VALLEY MS
38965-1904
US

IV. Provider business mailing address

1200 CENTRAL ST
WATER VALLEY MS
38965-1904
US

V. Phone/Fax

Practice location:
  • Phone: 662-714-4460
  • Fax: 662-714-4480
Mailing address:
  • Phone: 662-714-4460
  • Fax: 662-714-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17582
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: