| Doctor Name: | KIMBERLY GHOLAR |
| NPI Number: | 1376714667 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1814 Columbia Ave Ste B Prentiss, MS - 39474 |
| Business Phone Number: | 6017929329 |
| Business Fax Number: | 6017920664 |
| Mailing Address: | Po Box 177, PRENTISS |
| State: | MS |
| Postal Code: | 394740177 |
| Phone Number: | 6014413537 |
| Fax Number: | 6017920664 |
| NPI Enumeration Date: | 03/14/2008 |
| NPI Last Update Date: | 06/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |