Individual
MRS. KIMBERLY BASS FREDERICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
400 VETERANS AVE, (116B), BILOXI, MS 39531-2410
(228) 523-4241
(228) 523-4675
Mailing address
8118 GEORGIA AVE, GULFPORT, MS 39501-7541
(228) 868-1378
(228) 523-4675
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/24/2006
Last updated
07/08/2007
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