Healthcare Provider Details

I. General information

NPI: 1285183699
Provider Name (Legal Business Name): KIMBERLEA LEHR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8807 CLOVIS CT APT B
CLOVIS NM
88101-8592
US

IV. Provider business mailing address

8807 CLOVIS CT APT B
CLOVIS NM
88101-8592
US

V. Phone/Fax

Practice location:
  • Phone: 469-263-8224
  • Fax:
Mailing address:
  • Phone: 469-263-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: