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General NPI Number Information
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NPI Number | 1588491823
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI STATE UNIVERSITY
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 406 22ND AVE FL 3
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City | MERIDIAN
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State | MS
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Zip | 39301-5851
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Country | US
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Telephone | 601-484-0207
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 HIGHWAY 19 N
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City | MERIDIAN
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State | MS
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Zip | 39307-5771
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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 | MEDICAL BILLING SPECIALIST
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Name | KAY BOREN
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Credential |
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Telephone | 601-484-0207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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