Healthcare Provider Details

I. General information

NPI: 1144626334
Provider Name (Legal Business Name): KIMBERLY ANNE MARTIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 MONTCLAIR RD STE 101
BIRMINGHAM AL
35213-1218
US

IV. Provider business mailing address

2868 ACTON RD
VESTAVIA AL
35243-2502
US

V. Phone/Fax

Practice location:
  • Phone: 205-949-0099
  • Fax: 205-949-0363
Mailing address:
  • Phone: 205-968-8360
  • Fax: 205-968-8361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1134201
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: