Provider Demographics
NPI:1881737401
Name:NICHOLS, KIMBERLY P (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:P
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 E LAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9527
Mailing Address - Country:US
Mailing Address - Phone:601-936-9190
Mailing Address - Fax:601-932-6714
Practice Address - Street 1:291 E LAYFAIR DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9527
Practice Address - Country:US
Practice Address - Phone:601-936-9190
Practice Address - Fax:601-932-6714
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15805207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119701Medicaid
MS00119701Medicaid
MS160000444Medicare ID - Type Unspecified