MEDICARE: KATHY LYNN TIMMS PH.D., HCLD

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
1	247ZC0005X	Clinical Laboratory Director (Non-physician)

General Provider Information

NPI Number	:	1962602672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY LYNN TIMMS PH.D., HCLD

Provider Business Mailing Address
First Line	:	PO BOX 7687
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65205-7687
Country	:	US
Telephone Number	:	573-882-8612
Fax Number	:	573-884-4517

Provider Business Practice Location Address
First Line	:	500 N KEENE ST
Second Line	:	SUITE 200
City	:	COLUMBIA
State	:	MO
Zip	:	65201-8104
Country	:	US
Telephone Number	:	573-819-6618
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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