Provider Demographics
NPI:1891189767
Name:JOINER, KULMORIS
Entity Type:Individual
Prefix:
First Name:KULMORIS
Middle Name:
Last Name:JOINER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W WOODROW WILSON AVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7681
Mailing Address - Country:US
Mailing Address - Phone:601-807-5496
Mailing Address - Fax:769-233-8840
Practice Address - Street 1:350 WEST WOODROW WILSON AVENUE
Practice Address - Street 2:SUITE 145
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213
Practice Address - Country:US
Practice Address - Phone:601-807-5496
Practice Address - Fax:769-233-8840
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05671361376J00000X
MS06023302374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05671361Medicaid
MS06023302Medicaid