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General NPI Number Information
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NPI Number | 1801278163
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Entity Type | Organization
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Legal Business Name | KIMBERLEE CHARLES, MD, LLC
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 235 W 6TH ST
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City | RENO
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State | NV
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Zip | 89503-4548
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Country | US
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Telephone | 775-525-1523
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Fax |
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Provider Business Mailing Address
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Address Line | 235 W 6TH ST
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City | RENO
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State | NV
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Zip | 89503-4548
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Country | US
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Telephone | 775-525-1523
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLEE CHARLES
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Credential | MD
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Telephone | 775-525-1523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 15212
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License Number State | NV
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