Provider Demographics
NPI:1649517822
Name:NELSON, KIMBERLY S (DPT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:NELSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 HUNTINGTON HOLW
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-5208
Mailing Address - Country:US
Mailing Address - Phone:601-918-4780
Mailing Address - Fax:
Practice Address - Street 1:3208 SERVICE DR STE E
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-3539
Practice Address - Country:US
Practice Address - Phone:601-664-2044
Practice Address - Fax:601-664-3044
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist