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DR. KENTRELL MARIE LIDDELL M.D.
NPI 1659384063
Family Medicine in Jackson, MS

Active since August 15, 2006
2104 THOUSAND OAKS DR, JACKSON, MS 39212(601) 346-7450(601) 346-7451 Get Directions Write a Review

NPPES record last updated: April 9, 2013. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Kentrell Marie Liddell M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KENTRELL MARIE LIDDELL M.D. (NPI 1659384063) is an individual family medicine provider in Jackson, Mississippi, licensed in Mississippi (17997) and active in the NPI registry since August 2006.

NPPES Registry Identity

NPI1659384063
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameDR. KENTRELL MARIE LIDDELLCredential: M.D.
Location Address2104 THOUSAND OAKS DRJackson, MS 39212-2048
Mailing Address2104 Thousand Oaks DrJackson, MS 39212-2048 · (601) 346-7450 · Fax (601) 346-7451
Phone(601) 346-7450
Fax(601) 346-7451
Sole ProprietorYes
Enumeration DateAugust 15, 2006
Last NPPES UpdateApril 9, 2013
✔ NPI 1659384063 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in MS · 17997
Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

2104 THOUSAND OAKS DR, Jackson, MS 39212
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Other Identifiers 5

Other11859914MS · United Healthcare
Medicare PIN080004304MS
Medicaid08072071MS
Other$$$$$$$$$AMS · Blue Cross Blue Shield Of Ms
Medicare UPINI62916MS

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kentrell Liddell's NPI number?

The NPI number for Kentrell Liddell is 1659384063. It was assigned to this individual provider in the NPPES registry on August 15, 2006.

Where is Kentrell Liddell located?

Kentrell Liddell practices at 2104 Thousand Oaks Dr, Jackson, MS 39212. The listed phone number is (601) 346-7450.

What is Kentrell Liddell's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Kentrell Liddell was last updated on April 9, 2013. NPI Profile syncs with the weekly NPPES data releases published by CMS.