Provider Demographics
NPI:1275027443
Name:MCNAIR, KIMBERLY MYCHEL
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MYCHEL
Last Name:MCNAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 HUBB RD
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MS
Mailing Address - Zip Code:39041-9149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5260 CEDAR PARK DR STE E2
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4131
Practice Address - Country:US
Practice Address - Phone:601-966-1014
Practice Address - Fax:866-598-2650
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist