Healthcare Provider Details

I. General information

NPI: 1114733888
Provider Name (Legal Business Name): KIMBERLY MARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4171 LOMAC ST STE G
MONTGOMERY AL
36106-2945
US

IV. Provider business mailing address

4171 LOMAC ST STE G
MONTGOMERY AL
36106-2945
US

V. Phone/Fax

Practice location:
  • Phone: 877-295-4325
  • Fax:
Mailing address:
  • Phone: 877-295-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number187025
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: