Provider Demographics
NPI:1861366585
Name:PURNELL, KAY S
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:S
Last Name:PURNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:S
Other - Last Name:PURNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4193 PINEHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6737
Mailing Address - Country:US
Mailing Address - Phone:901-485-5917
Mailing Address - Fax:901-485-5917
Practice Address - Street 1:4193 PINEHURST BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-6737
Practice Address - Country:US
Practice Address - Phone:901-485-5917
Practice Address - Fax:901-485-5917
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-04
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD-2678133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered