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NPI Code Detail

MEDICARE: KIMBERLEY LYNN YASMINE DO

MEDICARE: KIMBERLEY LYNN YASMINE DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program125066551IL
2207Q00000XFamily Medicine Physician02006390AIN

General Provider Information

NPI Number : 1710367479
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLEY LYNN YASMINE DO
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1375 N GREEN ST STE 100
Second Line :
City : BROWNSBURG
State : IN
Zip : 46112-8734
Country : US
Telephone Number : 317-852-2251
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2015
Last Update Date : 08/10/2021

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Directions to “ KIMBERLEY LYNN YASMINE DO” Practice Location

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