Healthcare Provider Details

I. General information

NPI: 1154596492
Provider Name (Legal Business Name): MRS. KIMBERLY KAY HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KIMBERLY KAY HARMON

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W. 10TH STREET
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

408 SONHATSETT DRIVE
WESTFIELD IN
46074
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-2328
  • Fax: 317-988-2124
Mailing address:
  • Phone: 317-896-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: