Healthcare Provider Details

I. General information

NPI: 1750960241
Provider Name (Legal Business Name): KIMBERLY EMERICK IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18068 COASTAL HWY
LEWES DE
19958-4901
US

IV. Provider business mailing address

22471 OCALA WAY
LEWES DE
19958-2672
US

V. Phone/Fax

Practice location:
  • Phone: 302-567-1500
  • Fax:
Mailing address:
  • Phone: 732-239-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-301793
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0012006
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: