Healthcare Provider Details

I. General information

NPI: 1639948409
Provider Name (Legal Business Name): KIMBERLEY MULLINS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLEY BARDEN FNP-C

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 DEXTER AVENUE SUITE 4050
MONTGOMERY AL
36104
US

IV. Provider business mailing address

3590B PELHAM PKWY STE 240
PELHAM AL
35124-2034
US

V. Phone/Fax

Practice location:
  • Phone: 205-441-1088
  • Fax:
Mailing address:
  • Phone: 205-441-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-136196
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: