MEDICARE: JAMES KENT USRY LCSW

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	1041C0700X	Clinical Social Worker	4105	TN

General Provider Information

NPI Number	:	1962643320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES KENT USRY LCSW

Provider Business Mailing Address
First Line	:	COLUMBUS AFB 201 INDEPENDENCE DR
Second Line	:	14TH MEDICAL GROUP
City	:	COLUMBUS
State	:	MS
Zip	:	39710-0001
Country	:	US
Telephone Number	:	662-434-1126
Fax Number	:

Provider Business Practice Location Address
First Line	:	COLUMBUS AFB 201 INDEPENDENCE DR
Second Line	:	14TH MEDICAL GROUP
City	:	COLUMBUS
State	:	MS
Zip	:	39710-0001
Country	:	US
Telephone Number	:	662-434-1126
Fax Number	:	662-434-2246

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

Provider Enumeration Date	:	03/16/2009
Last Update Date	:	10/19/2012

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