Individual
KIMBERLY COGHLAN AGENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
407 S VALLEY ST, CARTHAGE, MS 39051-4051
(601) 298-0333
Mailing address
864 WILSON DR, SUITE C, RIDGELAND, MS 39157-4512
(601) 206-6100
(601) 206-6052
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R870206
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00150271
—
MS
Enumeration date
07/07/2010
Last updated
12/09/2013
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