Healthcare Provider Details

I. General information

NPI: 1962921619
Provider Name (Legal Business Name): TORY KIMPTON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 11/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

10535 HOSPITAL WAY BLDG 649
MATHER CA
95655-4200
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-2838
  • Fax:
Mailing address:
  • Phone: 916-843-9078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-203028
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY-203028
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: