Individual
KELLIE MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
116 N PAULINE ST, MEMPHIS, TN 38104-1005
(901) 523-8990
Mailing address
4625 BAKERSFIELD DR, NESBIT, MS 38651-6036
(901) 634-5312
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
5320
TN
Other
Enumeration date
05/20/2024
Last updated
05/20/2024
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