Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | E-8211 | AR |
N | 2086S0127X | Trauma Surgeon | 202330 | LA |
NPI | 1457561706 |
---|---|
Provider Name | Mary K Kimbrough |
First Address | Little Rock, AR 72205-7101 |
Second Address | Little Rock, AR 72205-7101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 24/02/2020 |