Provider Demographics
NPI:1699226399
Name:DAVIS, KIMBERLY F (NP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:F
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:300 SHERBORNE PL
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8959
Mailing Address - Country:US
Mailing Address - Phone:601-421-9537
Mailing Address - Fax:
Practice Address - Street 1:120 FOUNTAINS BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6343
Practice Address - Country:US
Practice Address - Phone:769-300-0700
Practice Address - Fax:601-990-2180
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901603363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS901603OtherAPRN
F06161208OtherNP CERT
MSR867828OtherRN LICENSE