MEDICARE: DR KIMBERLYANN MARSDEN 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
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1356010698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR KIMBERLYANN MARSDEN LLC

Provider Business Mailing Address
First Line	:	991 OCEAN BLUFF DR
Second Line	:
City	:	FERNANDINA
State	:	FL
Zip	:	32034-2297
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	991 OCEAN BLUFF DR
Second Line	:
City	:	FERNANDINA
State	:	FL
Zip	:	32034-2297
Country	:	US
Telephone Number	:	904-844-2344
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBERLYANN MARSDEN
Credential	:
Telephone Number	:	904-844-2344

Provider Enumeration Date	:	09/09/2021
Last Update Date	:	09/09/2021

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