Healthcare Provider Details

I. General information

NPI: 1861355307
Provider Name (Legal Business Name): KIMBERLY DEAN PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 OLDHAM ST
EMINENCE KY
40019-1337
US

IV. Provider business mailing address

67 OLDHAM ST
EMINENCE KY
40019-1337
US

V. Phone/Fax

Practice location:
  • Phone: 502-321-0299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number200101930
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: