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General NPI Number Information
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NPI Number | 1417288630
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Entity Type | Individual
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Provider Name | KIMBERLY ROSE EASTERLING RT(R) RDMS RVT
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Gender | Female
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 01/28/2010
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Provider Practice Location Address
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Address Line | 6221 HERMOSA DR
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-2512
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Country | US
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Telephone | 228-860-9341
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Fax |
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Provider Business Mailing Address
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Address Line | 6221 HERMOSA DR
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-2512
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Country | US
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Telephone | 228-860-9341
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Fax |
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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 | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | 165054
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | 9514
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License Number State | MS
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