Healthcare Provider Details

I. General information

NPI: 1548824006
Provider Name (Legal Business Name): KIMBERLY BIRCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 DELTONA BLVD
DELTONA FL
32725-8016
US

IV. Provider business mailing address

PO BOX 160261
ALTAMONTE SPRINGS FL
32716-0261
US

V. Phone/Fax

Practice location:
  • Phone: 386-259-5413
  • Fax:
Mailing address:
  • Phone: 502-472-7509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: