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General NPI Number Information
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NPI Number | 1861216756
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Entity Type | Individual
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Provider Name | KIMBERLY MICHELLE CROWELL PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 2011 23RD AVE
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City | MERIDIAN
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State | MS
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Zip | 39301-3110
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Country | US
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Telephone | 601-286-5983
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Fax |
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Provider Business Mailing Address
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Address Line | 3791 VALLEY RD
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City | MERIDIAN
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State | MS
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Zip | 39307-9406
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Country | US
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Telephone | 601-880-1852
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 907051
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License Number State | MS
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