Kimberly Philyaw, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

870393 Issued in MS

Practice address

290 Et Poole Rd
Poplarville, MS 39470-4007

Phone

(601) 337-0775

NPI assigned

Dec 30, 2020

Last updated

Jan 11, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Ripley, MS
  • NPI 1447769559

  Family

  Medicare reassignment NPD
• Keystone Medical Services of Ms, Inc

  • Emergency Medicine Physician
  • Hazlehurst, MS
  • NPI 1174691059
  Medicare reassignment NPD
• RH Emergency Medicine of Highland Community LLC

  • Emergency Medicine Physician
  • Picayune, MS
  • NPI 1033987946
  Medicare reassignment NPD
• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Kosciusko, MS
  • NPI 1851050579
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1356938831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 ET POOLE RD",
            "city": "POPLARVILLE",
            "state": "MS",
            "postal_code": "394704007",
            "telephone_number": "601-337-0775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 ET POOLE RD",
            "city": "POPLARVILLE",
            "state": "MS",
            "postal_code": "394704007",
            "telephone_number": "601-337-0775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILYAW",
        "first_name": "KIMBERLY",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-30",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "870393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Poplarville",
            "affiliation": "N",
            "address_1": "290 Et Poole Rd",
            "city": "Poplarville",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394704007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nursing Home Psychological Services, LLC
• Pearl River County Hospital
• Pearl River County Hospital
• Pearl River County Hospital Emergency Department
• Pearl River Drug Co.
• Picayune Eye Clinic (Poplarville Eye Clinic)
• Nancy Warden Pizzuto, COTA/L
• Poplarville Dental Clinic
• Poplarville Eye Clinic, LLC
• Poplarville Family Chiropractic

• Family Nurse Practitioner in Poplarville, MS
• Providers in Poplarville, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.