Provider Demographics
NPI:1568867455
Name:BINGHAM, KAYLORA L (FNP-C)
Entity Type:Individual
Prefix:
First Name:KAYLORA
Middle Name:L
Last Name:BINGHAM
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 1:3700 HARDY ST
Mailing Address - Street 2:STE 10
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1614
Mailing Address - Country:US
Mailing Address - Phone:601-545-8700
Mailing Address - Fax:601-450-2493
Practice Address - Street 1:44 BROOKLYN JANICE RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MS
Practice Address - Zip Code:39425-9731
Practice Address - Country:US
Practice Address - Phone:601-582-1188
Practice Address - Fax:601-582-8844
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR874229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04050575Medicaid
MS382546YJ9FMedicare PIN