=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518988120
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALLY L KIMBERLY CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2006
-----------------------------------------------------
Last Update Date | 03/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 SW ARCHER ROAD
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32610-0371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-392-4491
-----------------------------------------------------
Fax | 352-392-9912
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 918025
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32891-8025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-392-4491
-----------------------------------------------------
Fax | 352-392-9912
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | ARNP1606692
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------