Provider Demographics
NPI:1124618715
Name:AVERY, KARA M
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:M
Last Name:AVERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CANEBRAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-2211
Mailing Address - Country:US
Mailing Address - Phone:769-218-6885
Mailing Address - Fax:
Practice Address - Street 1:2115 STABLE LN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-2582
Practice Address - Country:US
Practice Address - Phone:769-218-6885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS85-2380684Medicaid