Healthcare Provider Details

I. General information

NPI: 1275199465
Provider Name (Legal Business Name): MISS KIMBERLY KAYANA TURNER-FRAZIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS KIMBERLY KAYANA TURNER-BRYAN

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4412 MENDOCINO BLVD
INDIANAPOLIS IN
46239
US

IV. Provider business mailing address

4412 MENDOCINO BLVD
INDIANAPOLIS IN
46239
US

V. Phone/Fax

Practice location:
  • Phone: 919-943-7881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC13132
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: