Healthcare Provider Details

I. General information

NPI: 1063236784
Provider Name (Legal Business Name): MS. ZEYRIA DEWITT KIMBROUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8410 BRAILE ST
DETROIT MI
48228-2808
US

IV. Provider business mailing address

8410 BRAILE ST
DETROIT MI
48228-2808
US

V. Phone/Fax

Practice location:
  • Phone: 313-400-7877
  • Fax:
Mailing address:
  • Phone: 313-400-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: