MEDICARE: KIMBERLEY BIVINS

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1033043567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEY BIVINS

Provider Business Mailing Address
First Line	:	509 KNOLLS DR UNIT 205
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23602-5744
Country	:	US
Telephone Number	:	757-698-5020
Fax Number	:	757-698-5020

Provider Business Practice Location Address
First Line	:	509 KNOLLS DR UNIT 205
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23602-5744
Country	:	US
Telephone Number	:	757-698-5020
Fax Number	:	757-698-5020

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

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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Directions to “ KIMBERLEY BIVINS ” Practice Location

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