Individual
KIMBERLY C. COVINGTON TARVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF MEDICINE/DIVISION OF GERIATRICS, JACKSON, MS 39216-4500
(601) 984-6426
(601) 984-6439
Mailing address
2500 NORTH STATE STREET, DIVISION OF GERIATRICS, JACKSON, MS 39216-4500
(601) 984-5610
(601) 984-5783
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
14422
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07483295
—
MS
01
—
P00462331
RAILROAD MEDICARE PTAN
MS
01
—
RR 110159204
RAILROAD
MS
Enumeration date
07/11/2006
Last updated
04/09/2014
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