Provider Demographics
NPI:1053477711
Name:LEMASTER, KIMBERLY RENEE (FNP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:RENEE
Last Name:LEMASTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LEMASTER
Other - Last Name:SNOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2152 MAGNOLIA-PISGAH RD.
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666
Mailing Address - Country:US
Mailing Address - Phone:601-248-4609
Mailing Address - Fax:601-783-5126
Practice Address - Street 1:111 MAGNOLIA STREET
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MS
Practice Address - Zip Code:39652
Practice Address - Country:US
Practice Address - Phone:601-783-2374
Practice Address - Fax:601-783-5126
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR743305207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02853573Medicaid
MSP63026Medicare UPIN
MS02853573Medicaid