Individual
KIMBERLY PIERCE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-6836
(601) 200-0128
Mailing address
PO BOX 23457, JACKSON, MS 39225-3457
(601) 200-6836
(601) 200-0128
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R865368
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07175291
—
MS
01
—
468179YKHV
MEDICARE ST DOM
MS
Enumeration date
08/24/2010
Last updated
07/20/2020
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