Provider Demographics
NPI:1548338791
Name:KIMSEY, MITZI JANE
Entity type:Individual
Prefix:MS
First Name:MITZI
Middle Name:JANE
Last Name:KIMSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MITZI
Other - Middle Name:JANE
Other - Last Name:BEASLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:125 DONS WAY
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-620-5231
Mailing Address - Fax:501-620-5109
Practice Address - Street 1:201 N 26TH ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4336
Practice Address - Country:US
Practice Address - Phone:870-243-1909
Practice Address - Fax:501-620-5109
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116399726Medicaid