Individual
ANN BUTLER KEMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-4778
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-4778
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
051027
GA
207Q00000X
Family Medicine Physician
Primary
20980
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000934722A
—
GA
01
—
302I083102
MEDICARE PTAN
MS
01
—
302I088508
MEDICARE ID
MS
05
—
G51027
—
SC
Enumeration date
08/30/2006
Last updated
05/12/2015
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