Healthcare Provider Details

I. General information

NPI: 1164411468
Provider Name (Legal Business Name): KIMBERLY A BROWN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1368 HIGHWAY 192 E
LONDON KY
40741-3123
US

IV. Provider business mailing address

PO BOX 1359 1368 E. HIGHWAY 192
LONDON KY
40743-1359
US

V. Phone/Fax

Practice location:
  • Phone: 606-864-6680
  • Fax: 606-864-7310
Mailing address:
  • Phone: 606-864-6680
  • Fax: 606-864-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number582
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6688
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: