Provider Demographics
NPI:1346498821
Name:AUSTIN, KIMBERLY JOLENE (MS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOLENE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-9485
Mailing Address - Country:US
Mailing Address - Phone:228-342-2446
Mailing Address - Fax:
Practice Address - Street 1:3604 N 10TH ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-9485
Practice Address - Country:US
Practice Address - Phone:228-342-2446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018214Medicaid