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General NPI Number Information
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NPI Number | 1700304151
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Entity Type | Individual
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Provider Name | MS. KIMBERLY MICHELLE DYE
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Gender | Female
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1015 SASSE ST
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City | CLARKSDALE
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State | MS
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Zip | 38614-7533
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Country | US
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Telephone | 662-645-9050
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Fax |
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Provider Business Mailing Address
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Address Line | 110 YAZOO AVE STE 220
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City | CLARKSDALE
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State | MS
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Zip | 38614-4329
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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 |
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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