The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, “Does your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Compared with the same specialty in Petal and Mississippi

1 active clinicians are listed under Licensed Practical Nurse with a practice address in Petal, MS (255 in Mississippi).

Addresses are self-reported to NPPES and may be out of date.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo · Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2025-05-28

Licensed Practical Nurse Primary Specialty

NUCC Taxonomy Code: 164W00000X

License # reported to NPPES MS 334167

An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

Registered Nurse - Community Health

NUCC Taxonomy Code: 163WC1500X

License # reported to NPPES MS 931616

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Mississippi State Medical Licensing Board.

Look Up on State Board Site

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

9 Historical Events

📍

Updated Practice Location May 28, 2025

Registered at 15 SUNLINE DR, PETAL, MS 394659029 (Tel: 6013251107)

👤

Provider Name / Credentials Updated May 28, 2025

Recorded as KIMBERLY PATRICK

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) May 28, 2025

Registered Nurse (license number reported to NPPES: MS 931616)

✅

NPI Profile Active December 28, 2017

NPI status registered as active in NPPES database

📍

Practice Location (Initial Record) December 28, 2017

Registered at 635 HAMPSHIRE DR, BRANDON, MS 390477797 (Tel: 6013251107)

📍

Business Mailing Address (Initial Record) December 28, 2017

Registered at 635 HAMPSHIRE DR, BRANDON, MS 390477797 (Tel: 6013251107)

👤

Provider Name / Credentials (Initial Record) December 28, 2017

Recorded as KIMBERLY TAYLOR

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) December 28, 2017

Licensed Practical Nurse (license number reported to NPPES: MS 334167)

🟢

Initial NPI Registration & Enumeration December 28, 2017

First registered as active Individual Practitioner in NPPES Database.

No reviews have been published yet. Leave a review.

NPI Administrative Meta

NPI Number: 1639685639

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: December 28, 2017

Last Update: May 28, 2025

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

635 Hampshire Dr

Brandon, MS 390477797

Phone: 6013251107

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.