MEDICARE: KIMBERLY PERSAUD

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1518624709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY PERSAUD

Provider Business Mailing Address
First Line	:	723 ESSEX ST PH
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-4407
Country	:	US
Telephone Number	:	347-600-9463
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 S 6TH ST STE 9
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-4643
Country	:	US
Telephone Number	:	612-977-5000
Fax Number	:

Authorized Official
Title or Position	:	KELLY BROOKS
Name	:	CAPELLA UNIVERSITY 1053078444
Credential	:	MPA
Telephone Number	:	612-977-5000

Provider Enumeration Date	:	11/22/2021
Last Update Date	:	11/22/2021

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Directions to “KIMBERLY PERSAUD ” Practice Location

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