Healthcare Provider Details

I. General information

NPI: 1881872695
Provider Name (Legal Business Name): KIMBERLY A BUCKINGHAM PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W MARKET ST STE 2900
INDIANAPOLIS IN
46204-2964
US

IV. Provider business mailing address

PO BOX 1433
PORTSMOUTH NH
03802-1433
US

V. Phone/Fax

Practice location:
  • Phone: 866-434-3255
  • Fax:
Mailing address:
  • Phone: 802-857-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number03433
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: