Provider Demographics
NPI:1609496058
Name:GUYTON, KIMBERLY CARROLL (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CARROLL
Last Name:GUYTON
Suffix:
Gender:F
Credentials:PA-C
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 1158
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1158
Mailing Address - Country:US
Mailing Address - Phone:662-371-1326
Mailing Address - Fax:662-371-1325
Practice Address - Street 1:1626 HIGHWAY 30 E
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-2319
Practice Address - Country:US
Practice Address - Phone:662-371-1326
Practice Address - Fax:662-371-1325
Is Sole Proprietor?:No
Enumeration Date:2020-04-25
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10039363A00000X
MSPA00766363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant