Provider Demographics
NPI:1124094453
Name:HARKINS, DENISE LYNN (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNN
Last Name:HARKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:WING
Other - Last Name:HARKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:DIVISION OF GENERAL INTERNAL MEDICINE
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5660
Mailing Address - Fax:601-984-6870
Practice Address - Street 1:2500 NORTH STATE ST
Practice Address - Street 2:DEPARTMENT OF MEDICINE DIVISION INTERNAL MEDICINE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01402450OtherRR MEDICARE
MS00123984Medicaid
MSP01402450OtherRR MEDICARE
MSH36748Medicare UPIN
MS302I118874Medicare PIN