Provider Demographics
NPI:1285838417
Name:HARRELL, KIMBERLY F (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:F
Last Name:HARRELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:FISCHER
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:902 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-3826
Mailing Address - Country:US
Mailing Address - Phone:601-684-2220
Mailing Address - Fax:
Practice Address - Street 1:902 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3826
Practice Address - Country:US
Practice Address - Phone:601-684-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00572861Medicaid