Organization
KIH ADVANCED KARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAD BLALACK (MANAGER)
(228) 861-4218
Entity
Organization
Contact information
Practice address
10281 CORPORATE DR, GULFPORT, MS 39503-4603
(228) 604-2155
Mailing address
10281 CORPORATE DR, GULFPORT, MS 39503-4603
(228) 604-2155
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/22/2021
Last updated
01/22/2021
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