Provider Demographics
NPI:1316418361
Name:MARTIN, KIMBERLY CATHLEEN (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CATHLEEN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:LEE-MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:607 OLD HIGHWAY 24 W
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:MS
Mailing Address - Zip Code:39643-5052
Mailing Address - Country:US
Mailing Address - Phone:601-674-0508
Mailing Address - Fax:
Practice Address - Street 1:607 OLD HIGHWAY 24 W
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:MS
Practice Address - Zip Code:39643-5052
Practice Address - Country:US
Practice Address - Phone:601-674-0508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202024363LP0808X
MS902882363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health