MEDICARE: DR. KIMBERLY PALMER RAY PHD, BCBA-D

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	103K00000X	Behavior Analyst	1-00-00351
2	103T00000X	Psychologist	36618	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851448963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY PALMER RAY PHD, BCBA-D

Provider Business Mailing Address
First Line	:	2001 NORTH WEST ST.
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39202-1037
Country	:	US
Telephone Number	:	601-709-5526
Fax Number	:	601-709-5527

Provider Business Practice Location Address
First Line	:	2001 N. WEST ST.
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39202-1037
Country	:	US
Telephone Number	:	601-709-5526
Fax Number	:	601-709-5527

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	12/19/2013

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