Provider Demographics
NPI:1417661604
Name:MCPHERSON, KYMBRANESHA (MS)
Entity Type:Individual
Prefix:
First Name:KYMBRANESHA
Middle Name:
Last Name:MCPHERSON
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:PO BOX 1336
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-1336
Mailing Address - Country:US
Mailing Address - Phone:662-524-4347
Mailing Address - Fax:
Practice Address - Street 1:16220 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-2639
Practice Address - Country:US
Practice Address - Phone:662-773-9377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1700894730OtherMENTAL HEALTH THERAPIST
MS1700894730Medicaid