Provider Demographics
NPI:1851448963
Name:RAY, KIMBERLY PALMER (PHD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:PALMER
Last Name:RAY
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 NORTH WEST ST.
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1037
Mailing Address - Country:US
Mailing Address - Phone:601-709-5526
Mailing Address - Fax:601-709-5527
Practice Address - Street 1:2001 N. WEST ST.
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1037
Practice Address - Country:US
Practice Address - Phone:601-709-5526
Practice Address - Fax:601-709-5527
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-00-00351103K00000X
MS36618103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119527Medicaid