Individual
MS. KIMBERLY CLYDE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-3356
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-3356
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R867005
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04728236
—
MS
Enumeration date
06/02/2015
Last updated
01/08/2018
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