Healthcare Provider Details

I. General information

NPI: 1942884960
Provider Name (Legal Business Name): BKT COLLECTION & EXTENSIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 GLITTER LN
WAYNESBORO MS
39367-2036
US

IV. Provider business mailing address

490 RIDGEWOOD DR
DAPHNE AL
36526-8030
US

V. Phone/Fax

Practice location:
  • Phone: 601-549-0710
  • Fax: 601-549-0710
Mailing address:
  • Phone: 601-549-0710
  • Fax: 601-549-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY SMITH
Title or Position: CFO/OWNER
Credential: RMA
Phone: 601-549-0710