Healthcare Provider Details

I. General information

NPI: 1558685008
Provider Name (Legal Business Name): KIMBERLY DAWN PRYOR M.S. CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 EMILYS WAY
CADIZ KY
42211-9210
US

IV. Provider business mailing address

174 EMILYS WAY
CADIZ KY
42211-9210
US

V. Phone/Fax

Practice location:
  • Phone: 270-350-0159
  • Fax:
Mailing address:
  • Phone: 270-350-0159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3729
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: