Healthcare Provider Details

I. General information

NPI: 1457675795
Provider Name (Legal Business Name): CHERYL LYNN KIMBRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W LEXINGTON AVE
WINCHESTER KY
40391-1357
US

IV. Provider business mailing address

505 COLLEGE ST
WINCHESTER KY
40391-1824
US

V. Phone/Fax

Practice location:
  • Phone: 859-744-6250
  • Fax:
Mailing address:
  • Phone: 859-595-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4015
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: