Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 14422 | MS |
NPI | 1013942895 |
---|---|
Provider Name | Kimberly C. Covington Tarver |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 09/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07483295 | (05) | MS |
G55482 | (02) | MS |
P00462331 | RAILROAD MEDICARE PTAN (01) | MS |
RR 110159204 | RAILROAD (01) | MS |