Provider Demographics
NPI:1710902390
Name:HARKINS, KIMBERLY G (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:G
Last Name:HARKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:G
Other - Last Name:HARKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:CBO-SUITE 4200
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-496-9794
Mailing Address - Fax:
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE DIVISION OF HYPERTENSION
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSRR 110217436OtherRAILROAD
MSP00462209OtherRAILROAD MEDICARE PTAN
MS00121807Medicaid
LA1390941Medicaid
MSH12705Medicare UPIN
MS302I117083Medicare PIN
MS00121807Medicaid
MSP00462209OtherRAILROAD MEDICARE PTAN
MS512I110013Medicare PIN