Provider Demographics
NPI:1871920108
Name:BENEFIELD, KIMMIE DYER
Entity type:Individual
Prefix:
First Name:KIMMIE
Middle Name:DYER
Last Name:BENEFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 BOONE ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-5908
Mailing Address - Country:US
Mailing Address - Phone:662-844-3531
Mailing Address - Fax:662-844-1757
Practice Address - Street 1:920 BOONE ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-5908
Practice Address - Country:US
Practice Address - Phone:662-844-3531
Practice Address - Fax:662-844-1757
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)