Provider Demographics
NPI:1083707814
Name:SUNDLAND, KIMBERLY AH (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:AH
Last Name:SUNDLAND
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3107
Mailing Address - Country:US
Mailing Address - Phone:601-264-3937
Mailing Address - Fax:601-264-5930
Practice Address - Street 1:415 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7246
Practice Address - Country:US
Practice Address - Phone:601-261-3606
Practice Address - Fax:601-579-5383
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3870367500000X
MSR813576367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02576323Medicaid
MS8824103OtherCIGNA
VAK142-0002OtherCARE FIRST 2005
VA139180OtherTRIGON
VA484645OtherNCPPO
VA1083707814Medicaid
MS3461546OtherUNITED HEALTHCARE
MS9840251OtherAETNA
MS302I439809OtherMEDICARE
MS9840251OtherAETNA
VA484645OtherNCPPO