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General NPI Number Information
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NPI Number | 1326733023
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Entity Type | Individual
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Provider Name | STACEY Y KIMBER LMY
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Gender | Female
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Dates
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Enumeration Date | 04/07/2023
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 146 RIVER SQUARE PLZ
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City | HUEYTOWN
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State | AL
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Zip | 35023-1667
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Country | US
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Telephone | 205-997-0175
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3650
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City | HUEYTOWN
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State | AL
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Zip | 35023-0650
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Country | US
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Telephone | 205-332-2868
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 6035
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License Number State | AL
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