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General NPI Number Information
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NPI Number | 1245571223
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Entity Type | Organization
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Legal Business Name | YOUR ENDOCRINOLOGY SPECIALIST, LLC
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Dates
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Enumeration Date | 03/15/2013
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Last Update Date | 03/15/2013
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Provider Practice Location Address
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Address Line | 5402 W ALOHA DR
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City | DIAMONDHEAD
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State | MS
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Zip | 39525-3329
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Country | US
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Telephone | 708-941-9722
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4094
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City | BILOXI
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State | MS
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Zip | 39535-4094
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KIMBERLY BARNES
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Credential |
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Telephone | 228-220-4194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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