Healthcare Provider Details

I. General information

NPI: 1790755585
Provider Name (Legal Business Name): KIM TIMMERMAN BAIRD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 BEDELL AVE
WOODBINE GA
31569-0307
US

IV. Provider business mailing address

308 BEDELL AVE
WOODBINE GA
31569-0308
US

V. Phone/Fax

Practice location:
  • Phone: 912-576-5999
  • Fax: 912-576-5888
Mailing address:
  • Phone: 912-576-5999
  • Fax: 912-576-5888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR051587
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: