=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225556798
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY WATKINS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2017
-----------------------------------------------------
Last Update Date | 04/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2688 US HIGHWAY 227
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41008-8030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-331-3292
-----------------------------------------------------
Fax | 859-534-2989
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 503 FARRELL DR
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41011-3775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-578-3200
-----------------------------------------------------
Fax | 859-534-2989
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 262645
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------