Provider Demographics
NPI:1073559100
Name:WARD, KIMBERLEY HELEN MORINE (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:HELEN MORINE
Last Name:WARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:HELEN
Other - Last Name:MORINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:UMMC-DEPARTMENT OF DERMATOLOGY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-3374
Mailing Address - Fax:601-853-6307
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21549207N00000X
GA059230207N00000X, 207NS0135X, 174400000X
TXM4639207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06852892Medicaid
MSP01034300OtherRAILROAD MEDICARE
MSP01402398OtherRR MEDICARE
MS333270YPPXMedicare PIN
MSP01034300OtherRAILROAD MEDICARE
MSP01402398OtherRR MEDICARE