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NPI Code Detail

MEDICARE: KMR PSYCHIATRIC SERVICES LLC

MEDICARE: KMR PSYCHIATRIC SERVICES LLC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053943779
Entity Type Code : Organization
Provider Name (Legal Business Name) : KMR PSYCHIATRIC SERVICES LLC
Provider Business Mailing Address
First Line : 4656 W JEFFERSON BLVD STE 285
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-6838
Country : US
Telephone Number : 260-422-9372
Fax Number :
Provider Business Practice Location Address
First Line : 4656 W JEFFERSON BLVD STE 285
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-6838
Country : US
Telephone Number : 260-422-9372
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KIMRA K REED
Credential : FNP-C, PMHNP
Telephone Number : 260-610-3057
Provider Enumeration Date : 02/11/2020
Last Update Date : 05/27/2020

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Directions to “KMR PSYCHIATRIC SERVICES LLC ” Practice Location

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