NPIMap

Individual provider Active NPI

Kimberly Coghlan Agent, FNP-C

  • Family Nurse Practitioner
  • Carthage, MS
National Provider Identifier
1871805820
Registry record updated Dec 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R870206 Issued in MS
Practice address
407 S Valley St
Carthage, MS 39051-4051
Phone
(601) 298-0333
NPI assigned
Jul 7, 2010
Last updated
Dec 9, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R870206 MS Primary

Addresses

Primary practice location

407 S Valley St
Carthage, MS 39051-4051

Mailing address

864 Wilson Dr
Suite C
Ridgeland, MS 39157-4512
Phone (601) 206-6100

Other identifiers 1

IdentifierTypeStateIssuer
00150271MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101027000689 MS Practitioner - Nurse Practitioner 9537353297 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

332 Hwy 12 W
Kosciusko, MS 39090-3209
Phone (662) 289-1800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R870206MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Medical Group of Mississippi LLC CurrentSince Sep 1, 2013 Accepting new patients
Baptist Medical Center-Leake, Inc. Past Accepting new patients
Baptist Medical Center-Leake, Inc Past Accepting new patients
Carthage Senior Care Past Accepting new patients
Premier Medical Group of Mississippi LLC Past Accepting new patients
Baptist Medical Center-Leake, Inc Past Accepting new patients

Locations

300 S Pearl St
#B
Carthage, MS 39051
Phone (601) 298-0333

407 S Valley St
Carthage, MS 39051
Phone (601) 298-0333

59 Montague St
Goodman, MS 39079
Phone (662) 739-6040

1200 N State St
Ste 480
Jackson, MS 39202
Phone (601) 352-2273

332 Highway 12 W
Kosciusko, MS 39090
Phone (601) 206-6100

530 Veterans Memorial Dr
Kosciusko, MS 39090
Phone (662) 289-9155

864 Wilson Dr
Ste C
Ridgeland, MS 39157
Phone (601) 206-6100

Interoperability endpoints

  • Direct secure messaging: kimberly.agent.1@27768.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1278460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386547200000",
    "number": "1871805820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "864 WILSON DR",
            "address_2": "SUITE C",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391574512",
            "telephone_number": "601-206-6100",
            "fax_number": "601-206-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 S VALLEY ST",
            "city": "CARTHAGE",
            "state": "MS",
            "postal_code": "390514051",
            "telephone_number": "601-298-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGENT",
        "first_name": "KIMBERLY",
        "middle_name": "COGHLAN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-07",
        "last_updated": "2013-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R870206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00150271",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carthage, MS

Sources for this page

Verify at the official NPI Registry.