Provider Demographics
NPI:1528600772
Name:WORD, KIMBERLY MITCHELL (FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MITCHELL
Last Name:WORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WELLS RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-7346
Mailing Address - Country:US
Mailing Address - Phone:662-582-2088
Mailing Address - Fax:
Practice Address - Street 1:102 CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-3250
Practice Address - Country:US
Practice Address - Phone:662-834-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty