=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720471279
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIRBY THOMPSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2015
-----------------------------------------------------
Last Update Date | 03/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 427 WEATHERSBY RD
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39402-1132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-855-6216
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1745 HIGHWAY 11
-----------------------------------------------------
City | PETAL
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39465-9382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-855-6216
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC00011
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 099.0101129
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------