Individual
KIRA BERCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1325 EAST FORTIFICATION, JACKSON, MS 39208
(601) 750-5445
Mailing address
1325 EAST FORTIFICATION, JACKSON, MS 39208
(601) 750-5445
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0361
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811280985
—
MS
Enumeration date
05/24/2011
Last updated
12/30/2014
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