Provider Demographics
NPI:1023808318
Name:DUKES, KIA (OMT)
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:
Last Name:DUKES
Suffix:
Gender:F
Credentials:OMT
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 162
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-0162
Mailing Address - Country:US
Mailing Address - Phone:662-507-5990
Mailing Address - Fax:
Practice Address - Street 1:881 COUNTY ROAD 115
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-9519
Practice Address - Country:US
Practice Address - Phone:662-507-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist