MEDICARE: KIMBERLY GAITES MS

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	171M00000X	Case Manager/Care Coordinator		FL

Other Identifiers

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

General Provider Information

NPI Number	:	1306110929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY GAITES MS

Provider Business Mailing Address
First Line	:	5271 BEACHBLANKET CIR
Second Line	:
City	:	HUTCHINSON ISLAND
State	:	FL
Zip	:	34949-8406
Country	:	US
Telephone Number	:	203-233-2782
Fax Number	:

Provider Business Practice Location Address
First Line	:	5271 BEACHBLANKET CIR
Second Line	:
City	:	HUTCHINSON ISLAND
State	:	FL
Zip	:	34949-8406
Country	:	US
Telephone Number	:	203-233-2782
Fax Number	:

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

Provider Enumeration Date	:	02/29/2012
Last Update Date	:	07/21/2022

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