Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 11741 | MS |
NPI | 1013002997 |
---|---|
Provider Name | Dr. Robert Carson Kirksey |
First Address | Jackson, MS 39207-3079 |
Second Address | Tupelo, MS 38801-4934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 07/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00015278 | (05) | MS |
009944815 | (05) | AL |
D80485 | (02) |