Basic Information
| Provider Information | |||||||||
| NPI: | 1720536675 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARNEY | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | TRIGG | ||||||||
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| Credential: | MS CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 156 E WALNUT AVE | ||||||||
| Address2: | |||||||||
| City: | EUPORA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397442027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622588293 | ||||||||
| FaxNumber: | 6622582345 | ||||||||
| Practice Location | |||||||||
| Address1: | 156 E WALNUT AVE | ||||||||
| Address2: | |||||||||
| City: | EUPORA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397442027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622588293 | ||||||||
| FaxNumber: | 6622582345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2016 | ||||||||
| LastUpdateDate: | 09/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | S0937 | MS | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.