Individual
KIMBERLY GHOLAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1814 COLUMBIA AVE STE B, PRENTISS, MS 39474-0177
(601) 792-0664
(844) 274-1342
Mailing address
PO BOX 177, PRENTISS, MS 39474-0177
(601) 441-3537
(601) 792-0664
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
—
246RP1900X
Phlebotomy Technician
—
—
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
03/14/2008
Last updated
02/08/2024
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