Individual
MR. KEVIN M WHALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
965 JK AVENT DR, SUITE 103, GRENADA, MS 38901
(662) 226-4088
(662) 226-0198
Mailing address
965 JK AVENT DR, SUITE 103, GRENADA, MS 38901
(662) 226-4088
(662) 226-0198
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
14578
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115400
—
MS
Enumeration date
10/23/2006
Last updated
06/06/2008
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