Healthcare Provider Details

I. General information

NPI: 1356486989
Provider Name (Legal Business Name): KIMBERLY B BRAUN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date: 03/13/2007
Reactivation Date: 05/15/2007

III. Provider practice location address

4100 W 3RD ST
DAYTON OH
45428-9000
US

IV. Provider business mailing address

4100 W 3RD ST
DAYTON OH
45428-9000
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax:
Mailing address:
  • Phone: 937-268-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5600
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: