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General NPI Number Information
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NPI Number | 1427656230
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Entity Type | Individual
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Provider Name | KIMBERLY MICHELE MYER FNP
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Gender | Female
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Dates
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Enumeration Date | 10/14/2020
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 220 HIGHWAY 12 W
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City | KOSCIUSKO
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State | MS
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Zip | 39090-3208
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Country | US
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Telephone | 662-290-3150
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11407 DEPT 2639
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City | BIRMINGHAM
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State | AL
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Zip | 35246-2639
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Country | US
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Telephone | 601-292-4562
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 904201
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 864405
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License Number State | MS
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