Provider Demographics
NPI:1356667455
Name:MARLAR, KIMBERLY KUYKENDALL (FNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KUYKENDALL
Last Name:MARLAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 ALCORN DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9323
Mailing Address - Country:US
Mailing Address - Phone:662-287-5218
Mailing Address - Fax:662-286-3186
Practice Address - Street 1:611 ALCORN DR STE 230
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9323
Practice Address - Country:US
Practice Address - Phone:662-287-5218
Practice Address - Fax:662-286-3186
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily