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General NPI Number Information
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NPI Number | 1134565765
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Entity Type | Individual
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Provider Name | KIMBERLY LYNN SIMERLY
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Gender | Female
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 7901 4TH ST N STE 300
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4399
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Country | US
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Telephone | 423-281-5053
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Fax |
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Provider Business Mailing Address
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Address Line | 254 S COUNTY HIGHWAY 393 UNIT 7
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-4278
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Country | US
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Telephone | 423-647-3817
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | TPSW332
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6498
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW020662
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 089.0135458
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License Number State | VT
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | MBTSWO-44335
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License Number State | ID
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