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General NPI Number Information
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NPI Number | 1982965372
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Entity Type | Individual
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Provider Name | KIMBERLY JANE LAYNE L.AC.
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Gender | Female
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Dates
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Enumeration Date | 06/03/2012
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Last Update Date | 06/03/2012
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Provider Practice Location Address
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Address Line | 4419 FRONTIER TRL SUITE 106
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City | AUSTIN
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State | TX
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Zip | 78745-1686
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Country | US
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Telephone | 602-743-0023
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 SOUTHPORT DR #145
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City | AUSTIN
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State | TX
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Zip | 78704-7791
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Country | US
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Telephone | 602-743-0023
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC01357
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License Number State | TX
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