Healthcare Provider Details

I. General information

NPI: 1902168982
Provider Name (Legal Business Name): KIMBERLI VONKEY PITTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15818 SW WARFIELD BLVD
INDIANTOWN FL
34956-3513
US

IV. Provider business mailing address

3493 SE JAKE CT APT 98
STUART FL
34994-5057
US

V. Phone/Fax

Practice location:
  • Phone: 772-597-0411
  • Fax: 772-597-0412
Mailing address:
  • Phone: 772-985-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: