Provider Demographics
NPI:1235373663
Name:NAGEL, KIM ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:ELLIOT
Last Name:NAGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4128
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39304-4128
Mailing Address - Country:US
Mailing Address - Phone:601-581-7687
Mailing Address - Fax:601-483-5543
Practice Address - Street 1:4555 HIGHLAND PARK DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-5429
Practice Address - Country:US
Practice Address - Phone:601-581-7687
Practice Address - Fax:601-483-5543
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS200882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02855315Medicaid
299516YS54Medicare PIN