Healthcare Provider Details

I. General information

NPI: 1417935586
Provider Name (Legal Business Name): KIMBERLY KAY GULLICKSON AU.D. CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 TURNER STREET BRANCH HEALTH CLINIC NAVAL AIR STATION
PENSACOLA FL
32508
US

IV. Provider business mailing address

450 TURNER STREET BRANCH HEALTH CLINIC NAVAL AIR STATION
PENSACOLA FL
32508
US

V. Phone/Fax

Practice location:
  • Phone: 850-452-5242
  • Fax:
Mailing address:
  • Phone: 850-452-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT005774
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: