Individual
KIM DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
112 W PEELER AVE, SHAW, MS 38773-8710
(662) 754-3301
Mailing address
112 W PEELER AVE, SHAW, MS 38773-8710
(662) 754-3301
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
904961
MS
Other
Enumeration date
12/01/2021
Last updated
12/01/2021
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