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NPI Code Detail

MEDICARE: KIMBERLY D YADA MSW, LCSW

MEDICARE: KIMBERLY D YADA MSW, LCSW
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
11041C0700XClinical Social Worker989- CAR

General Provider Information

NPI Number : 1720024102
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY D YADA MSW, LCSW
Provider Business Mailing Address
First Line : 1090 ARNOLD DR
Second Line :
City : LITTLE ROCK AIR FORCE BASE
State : AR
Zip : 72099-4933
Country : US
Telephone Number : 501-987-8811
Fax Number :
Provider Business Practice Location Address
First Line : 1090 ARNOLD DR
Second Line :
City : LITTLE ROCK AIR FORCE BASE
State : AR
Zip : 72099-4933
Country : US
Telephone Number : 501-987-8811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2006
Last Update Date : 04/24/2025

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