Provider Demographics
NPI:1689614240
Name:CROWDER, KIMBERLY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:CROWDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:SUITE B319
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5022
Mailing Address - Fax:601-815-3773
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:SUITE B319
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-4788
Practice Address - Fax:601-815-3773
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17144207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04580379Medicaid
MSP00051393OtherRAILROAD MEDICARE
MS512I180009Medicare PIN
MS180000301Medicare ID - Type Unspecified
MSP01175267Medicare PIN
MSI16965Medicare UPIN
MSP00051393OtherRAILROAD MEDICARE