Kimberly Drake
Individual provider Active NPI In Home Supportive Care Agency · Shaw, MS
NPI 1386214484 · NPPES record last updated Jun 30, 2021
Key facts
- NPI
- 1386214484
- Entity type
- Individual (NPI type 1)
- Primary specialty
- In Home Supportive Care Agency 253Z00000X
- Practice address
- 500 Caanan Street
Shaw, MS 38773 - Phone
- (662) 719-8467
- NPI assigned
- Jun 30, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | |||
| In Home Supportive Care Agency | 253Z00000X | Yes |
Addresses
Primary practice location
500 Caanan Street
Shaw, MS 38773
Mailing address
P.O. Box 516
Shaw, MS 38773
Phone (662) 719-8467
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All providers in Shaw, MS · In Home Supportive Care Agency in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2021. 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.