Individual
KIMBERLY NICOLE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
150 JEFF DAVIS BLVD, NATCHEZ, MS 39120-5107
(601) 446-6634
Mailing address
3444 WISCONSIN AVE, VICKSBURG, MS 39180-5331
(601) 638-0031
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
101YM0800X
MS
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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