Basic Information
| Provider Information | |||||||||
| NPI: | 1548204746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEMP | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 878 LAKELAND DR | ||||||||
| Address2: | LB-BUILDING | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018151078 | ||||||||
| FaxNumber: | 6019846994 | ||||||||
| Practice Location | |||||||||
| Address1: | 878 LAKELAND DR | ||||||||
| Address2: | LB-BUILDING | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018151078 | ||||||||
| FaxNumber: | 6019846994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 09/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 15704 | MS | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | P01236773 | 01 | MS | RAILROAD MEDICARE PTAN | OTHER | 00118248 | 05 | MS | MEDICAID | P00462249 | 01 | MS | RAILROAD MEDICARE PTAN | OTHER | 104193 | 05 | AL | MEDICAID |