OrganizationActive
Vicksburg Allergy and Asthma
NPI 1619140399 · Allergy & Immunology Physician · Vicksburg, MS
Provider details
- NPI number
- 1619140399
- Entity type
- Organization
- Primary specialty
- Allergy & Immunology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Timothy Kerut, President(601) 636-0097
- License
- 11047 (MS)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(87/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
104 Mcauley Dr
Vicksburg, MS 39183-2825
Phone: (601) 636-0097
Fax: (601) 629-9969
Street-level locationGet directions
Mailing address
107 Carlton Place Dr
Vicksburg, MS 39180-1822
Registry dates
- Enumerated
- 2008-04-02
- Last updated
- 2008-04-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.