Provider Demographics
NPI:1548204746
Name:KEMP, STEPHEN F (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:F
Last Name:KEMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 LAKELAND DR
Mailing Address - Street 2:LB-BUILDING
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-1078
Mailing Address - Fax:601-984-6994
Practice Address - Street 1:878 LAKELAND DR
Practice Address - Street 2:LB-BUILDING
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-1078
Practice Address - Fax:601-984-6994
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15704207K00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01236773OtherRAILROAD MEDICARE PTAN
MS00118248Medicaid
MSP00462249OtherRAILROAD MEDICARE PTAN
AL104193Medicaid
MSP00462249OtherRAILROAD MEDICARE PTAN
MS512I110037Medicare PIN
MS030000021Medicare ID - Type Unspecified
AL104193Medicaid