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General NPI Number Information
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NPI Number | 1073506721
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Entity Type | Individual
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Provider Name | KIMBERLEY ROYAL GIBSON MS CCC SLP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4906 OLD HIGHWAY 11 STE 8
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City | HATTIESBURG
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State | MS
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Zip | 39402-8874
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Country | US
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Telephone | 601-268-9877
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Fax | 601-268-9609
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Provider Business Mailing Address
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Address Line | 4906 OLD HIGHWAY 11 STE 8
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City | HATTIESBURG
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State | MS
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Zip | 39402-8874
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Country | US
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Telephone | 601-268-9877
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Fax | 601-268-9609
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | S1168
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License Number State | MS
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