Healthcare Provider Details

I. General information

NPI: 1962602672
Provider Name (Legal Business Name): KATHY LYNN TIMMS PH.D., HCLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N KEENE ST SUITE 200
COLUMBIA MO
65201-8104
US

IV. Provider business mailing address

PO BOX 7687
COLUMBIA MO
65205-7687
US

V. Phone/Fax

Practice location:
  • Phone: 573-819-6618
  • Fax:
Mailing address:
  • Phone: 573-882-8612
  • Fax: 573-884-4517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: