Provider Demographics
NPI:1760213235
Name:MOULARD, KEM P (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:KEM
Middle Name:P
Last Name:MOULARD
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:MR
Other - First Name:KEM
Other - Middle Name:P
Other - Last Name:MOULARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:150 JEFFERSON DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-5107
Mailing Address - Country:US
Mailing Address - Phone:601-492-4001
Mailing Address - Fax:601-442-3451
Practice Address - Street 1:150 JEFFERSON DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5107
Practice Address - Country:US
Practice Address - Phone:601-492-4001
Practice Address - Fax:601-442-3451
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906860363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health