Individual
MRS. KIMBRELL EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
117 TALONS TRL, MADISON, MS 39110-6020
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3589
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07623091
—
MS
Enumeration date
11/16/2011
Last updated
12/11/2012
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