Individual
DR. KIM L. GRATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2500 N STATE ST, H801, DEPARTMENT OF PSYCHIATRY, JACKSON, MS 39216-4500
(601) 815-6450
(601) 984-4489
Mailing address
2500 N STATE ST, H801, DEPARTMENT OF PSYCHIATRY, JACKSON, MS 39216-4500
(601) 815-6450
(601) 984-4489
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
48 831
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
302I680217
MEDICARE PTAN
MS
Enumeration date
02/21/2009
Last updated
06/29/2012
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