MEDICARE: KIMMIE WEBB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2000088673	OTHER	NV	DRIVER'S LICENSE

General Provider Information

NPI Number	:	1023506102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMMIE WEBB

Provider Business Mailing Address
First Line	:	4216 ORION AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3222
Country	:	US
Telephone Number	:	702-498-9248
Fax Number	:

Provider Business Practice Location Address
First Line	:	4216 ORION AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3222
Country	:	US
Telephone Number	:	702-498-9248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2018
Last Update Date	:	04/25/2018

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Directions to “ KIMMIE WEBB ” Practice Location

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