Victoria Kivlan, AU.D
Individual provider Active NPI Audiologist · Jackson, MS
NPI 1225404841 · NPPES record last updated Jul 23, 2018
Key facts
- NPI
- 1225404841
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Audiologist 231H00000X
- License
- A4056 (MS)
- Practice address
- 2500 North State Street
Jackson, MS 39216 - Phone
- (601) 815-6064
- Fax
- (601) 984-5085
- NPI assigned
- Aug 18, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80755 | TX | MD | Hearing Instrument Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 80755 | TX | |
| Audiologist | 231H00000X | A4056 | MS | Yes |
Addresses
Primary practice location
2500 North State Street
Jackson, MS 39216
Mailing address
2500 North State Street
Jackson, MS 39216-4500
Phone (601) 815-6064
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03232225 | Medicaid | MS |
Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.