Provider Demographics
NPI:1609024835
Name:KIMBROUGH, JUNE G (FNP)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:G
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 FOUNTAINS BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6318
Mailing Address - Country:US
Mailing Address - Phone:769-300-0730
Mailing Address - Fax:769-300-0734
Practice Address - Street 1:129 FOUNTAINS BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6318
Practice Address - Country:US
Practice Address - Phone:769-300-0730
Practice Address - Fax:769-300-0734
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR733641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily