MEDICARE: STEPHANIE KIMBER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	907717	MS
2	363LF0000X	Family Nurse Practitioner	39728	TN

General Provider Information

NPI Number	:	1811827579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE KIMBER

Provider Business Mailing Address
First Line	:	PO BOX 1678
Second Line	:
City	:	TUNICA
State	:	MS
Zip	:	38676-1678
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 1678
Second Line	:
City	:	TUNICA
State	:	MS
Zip	:	38676-1678
Country	:	US
Telephone Number	:	662-402-1812
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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Directions to “ STEPHANIE KIMBER ” Practice Location

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