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General NPI Number Information
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NPI Number | 1447594635
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Entity Type | Organization
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Legal Business Name | KIMBERLY NELSON KENT PHD LLC
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Dates
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Enumeration Date | 11/12/2012
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 175 RIVER OAKS CIR
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City | SANFORD
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State | FL
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Zip | 32771-9321
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Country | US
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Telephone | 407-810-9357
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Fax |
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Provider Business Mailing Address
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Address Line | 175 RIVER OAKS CIR
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City | SANFORD
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State | FL
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Zip | 32771-9321
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Country | US
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Telephone | 407-810-9357
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. KIMBERLY KENT
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Credential | PHD
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Telephone | 407-810-9357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | PY8080
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | PY8080
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License Number State | FL
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