Healthcare Provider Details
I. General information
NPI: 1669448643
Provider Name (Legal Business Name): DAPHENE LUVATA KIMBALL-BUTLER RN.PCM.CLC.SANE.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 02/28/2006
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4778 N HENRY BLVD
STOCKBRIDGE GA
30281-3566
US
IV. Provider business mailing address
40 BLAKE AVE
PORTERDALE GA
30014-5016
US
V. Phone/Fax
- Phone: 706-650-5793
- Fax: 770-786-2223
- Phone: 706-650-5793
- Fax: 770-786-2223
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | RN136141 |
| License Number State | GA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0400X |
| Taxonomy | Case Management Registered Nurse |
| License Number | RN136141 |
| License Number State | GA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WL0100X |
| Taxonomy | Lactation Consultant (Registered Nurse) |
| License Number | RN136141 |
| License Number State | GA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WM0102X |
| Taxonomy | Maternal Newborn Registered Nurse |
| License Number | RN136141 |
| License Number State | GA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1600X |
| Taxonomy | Continuing Education/Staff Development Registered Nurse |
| License Number | RN136141 |
| License Number State | GA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WW0000X |
| Taxonomy | Wound Care Registered Nurse |
| License Number | RN136141 |
| License Number State | GA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0400X |
| Taxonomy | Case Management Registered Nurse |
| License Number | R73283 |
| License Number State | SC |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | R73283 |
| License Number State | SC |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WL0100X |
| Taxonomy | Lactation Consultant (Registered Nurse) |
| License Number | R73283 |
| License Number State | SC |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WM0102X |
| Taxonomy | Maternal Newborn Registered Nurse |
| License Number | R73283 |
| License Number State | SC |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1600X |
| Taxonomy | Continuing Education/Staff Development Registered Nurse |
| License Number | R73283 |
| License Number State | SC |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WX0002X |
| Taxonomy | High-Risk Obstetric Registered Nurse |
| License Number | R73283 |
| License Number State | SC |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP1700X |
| Taxonomy | Perinatal Registered Nurse |
| License Number | R73283 |
| License Number State | SC |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WW0000X |
| Taxonomy | Wound Care Registered Nurse |
| License Number | R73283 |
| License Number State | SC |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
