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General NPI Number Information
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NPI Number | 1992911598
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Entity Type | Individual
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Provider Name | KIMBERLY KERR INGRAM D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 2104 HARDY ST
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City | HATTIESBURG
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State | MS
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Zip | 39401
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Country | US
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Telephone | 601-583-4004
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Fax | 601-583-4005
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Provider Business Mailing Address
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Address Line | P.O. BOX 15068
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City | HATTIESBURG
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State | MS
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Zip | 39404-5068
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Country | US
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Telephone | 601-583-4004
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Fax | 601-583-4005
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3006-97
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License Number State | MS
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