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General NPI Number Information
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NPI Number | 1922469063
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Entity Type | Individual
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Provider Name | KIMBERLY ANN TYNER NP-C
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Gender | Female
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 514 E WOODROW WILSON AVE STE F
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City | JACKSON
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State | MS
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Zip | 39216-4538
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Country | US
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Telephone | 601-982-3132
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Fax | 601-982-3136
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Provider Business Mailing Address
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Address Line | 1824 AUGUST BND
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City | MADISON
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State | MS
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Zip | 39110-6825
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Country | US
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Telephone | 601-941-3863
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R824497
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License Number State | MS
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