DR. KUSHNA K DAMALLIE (NPI# 1861488215) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861488215 |
| Entity Type | Individual |
| Full Name | DR. KUSHNA K DAMALLIE |
| Credential | MD |
| Practice Address |
2000 N State St Clarksdale MS 38614-6100 |
| Practice Telephone | 6626277361 |
| Practice Fax Number | 6626271158 |
| Mailing Telephone | 6626277361 |
| Mailing Fax Number | 6626271158 |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 18061 | MS | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | ARK BCBS | 82604 | 01 |
| MS | 09035591 | 05 | |
| MS | ARK MEDICAID | 150159001 | 01 |
| Street Address |
2000 N STATE ST |
| City | CLARKSDALE |
| State | MS |
| Zip Code | 38614-6100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346233442 | Bouldin A Marley Jr. | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2005-08-24 |
| 1346735057 | Teresa Victoria White Powell | Nurse Practitioner | 2000 N State St, Clarksdale, MS 38614-6100 | 2018-06-25 |
| 1477898112 | Woman's Clinic, A Professional Association | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2012-12-06 |
| 1215195631 | Kimberly Tanner Fava | Nurse Practitioner | 2000 N State St, Clarksdale, MS 38614-6100 | 2008-06-02 |
| 1629293113 | Frank T. Marascalco, M.d., P.a. | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2007-04-17 |
| 1730104928 | Delphia M Hord | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2006-07-12 |
| 1982690061 | Linda D Wright | Nurse Practitioner | 2000 N State St, Clarksdale, MS 38614-6100 | 2005-09-23 |
| 1366438772 | Erica R Balthrop | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2005-09-21 |
| 1043203136 | Womans Clinic, A Professional Association | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2005-08-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386265627 | Lillie Mae Lockett | Technician | 1025 Ritchie Ave, Clarksdale, MS 38614 | 2020-04-28 |
| 1063957751 | Autospa-healthy Youth Center | Nurse Practitioner | 1202 Desoto Ave, Suite A, Clarksdale, MS 38614 | 2017-01-04 |
| 1700226123 | Nikki Nikkia Cager | Internal Medicine | 785 Ohio Ave Ste 2d, Clarksdale, MS 38614 | 2013-06-29 |
| 1205186947 | Celestial Comfort Care Hospice | Hospice Care, Community Based | 110 Yazoo Ave. Suite 212, Clarksdale, MS 38614 | 2012-09-10 |
| 1063667129 | The Smile Center of Clarksdale | Clinic/Center | 526 Choctaw Street, Suites B & C, Clarksdale, MS 38614 | 2008-11-17 |
| 1801060033 | Clarksdale Municipal School District | Local Education Agency (LEA) | Gycelle Tynes Educational Center, Friars Point Road, Clarksdale, MS 38614 | 2008-04-18 |
| 1184806150 | Mary A Williams | Nurse Practitioner | 125 Highway 322, Clarksdale, MS 38614 | 2007-12-03 |
| 1114040367 | William F Wilson Jr. | Dentist | 850 Desoto Ave, Extended, Clarksdale, MS 38614 | 2007-04-10 |
| 1952434920 | Kathleen Tinnel | Nurse Practitioner | 2245 N State St, Clarksdale, MS 38614 | 2007-03-13 |
| 1497888457 | Carole L Mangrem | Pediatrics | 2245 N Starte St, Clarksdale, MS 38614 | 2007-03-13 |
| Find all providers in zip 38614 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669692620 | Therapeutic Exprexxions Rehab, Inc. | Specialist | 122 Desoto Ave, Suite 109, Clarksdale, MS 38614-4420 | 2007-05-01 |
| 1144373994 | Wafa Saba | Specialist | 927 May St, Clarksdale, MS 38614-3602 | 2007-01-18 |
| 1346340981 | G D Berryhill Jr. | Specialist | 860 Desoto Avenue Ext, Clarksdale, MS 38614-2003 | 2006-09-24 |
| 1003836669 | Irene Buckner | Specialist | 1967 Hospital Dr, Clarksdale, MS 38614 | 2006-07-19 |
| 1346233442 | Bouldin A Marley Jr. | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2005-08-24 |
| 1477898112 | Woman's Clinic, A Professional Association | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2012-12-06 |
| 1508038977 | Crossroads Urology | Specialist | 785 Ohio Ave, Suite 1b, Clarksdale, MS 38614-6217 | 2008-03-26 |
| 1598955460 | Clarksdale Hma LLC | Specialist | 1970 Hospital Dr, Clarksdale, MS 38614-7202 | 2007-07-27 |
| 1457554479 | Internal Medicine Clinic of Clarksdale | Specialist | 1967 Hospital Dr, Clarksdale, MS 38614-7203 | 2007-06-07 |
| 1629293113 | Frank T. Marascalco, M.d., P.a. | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2007-04-17 |
| Find all providers in CLARKSDALE | ||||
| City | CLARKSDALE |
| Zip Code | 38614 |
Please comment or provide details below to improve the information on DR. KUSHNA K DAMALLIE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.