Kenneth Bryan Gautier, MD is a
Pediatrics - Sports Medicine physician based in Senatobia, Mississippi. Kenneth Bryan Gautier is licensed to practice in Mississippi (license number 18615) and his current practice location is 103 Halls Cv, Senatobia, Mississippi. He can be reached at his office (for appointments etc.) via phone at
(662) 562-9003.
NPI number for Kenneth Bryan Gautier is 1467551465 and his current mailing address is 103 Halls Cv, Senatobia, Mississippi. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1467551465.
Physician's Profile
Full Name | Kenneth Bryan Gautier |
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Gender | Male |
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Speciality | Pediatrics - Sports Medicine |
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Location | 103 Halls Cv, Senatobia, Mississippi |
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Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
NPI Data:
- NPI Number: 1467551465
- Provider Enumeration Date: 09/22/2006
- Last Update Date: 02/29/2012
Medical Identifiers
Medical identifiers for Kenneth Bryan Gautier such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1467551465 | NPI | - | NPPES |
06727534 | Medicaid | MS | |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
2080S0010X | Pediatrics - Sports Medicine | 18615 (Mississippi) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kenneth Bryan Gautier is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Kenneth Bryan Gautier, MD 103 Halls Cv, Senatobia, MS 38668-6620 Ph: (662) 562-9003 | Kenneth Bryan Gautier, MD 103 Halls Cv, Senatobia, MS 38668-6620 Ph: (662) 562-9003 |
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