Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Vicksburg Allergy and Asthma

Organization Allergy & Immunology Physician · NPI 1619140399

Vicksburg Allergy and Asthma is an Allergy & Immunology Physician in Vicksburg, Mississippi. Licensed in Mississippi. Registered with an NPI since 2008.

Licensed in
MS
In the registry since
2008

Practice location Address checks out

104 McAuley Dr
Vicksburg, MS 39183-2825
Phone: (601) 636-0097
Fax: (601) 629-9969
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Allergy & Immunology Physician (primary) Taxonomy 207K00000X · Licence 11047 (MS)

Record details

NPI number1619140399
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Timothy Kerut — President · (601) 636-0097
NPI enumeratedApril 2, 2008
Last updated in NPPESApril 2, 2008
Mailing address107 Carlton Place Dr, Vicksburg, MS 39180-1822

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