MEDICARE: MS. KIMBERLY MCCULLOUGH OBAT NAVIGATOR

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

General Provider Information

NPI Number	:	1689391781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY MCCULLOUGH OBAT NAVIGATOR

Provider Business Mailing Address
First Line	:	15 E REDMAN AVE STE A
Second Line	:
City	:	HADDONFIELD
State	:	NJ
Zip	:	08033-2316
Country	:	US
Telephone Number	:	844-542-2273
Fax Number	:	856-428-0702

Provider Business Practice Location Address
First Line	:	15 E REDMAN AVE STE A
Second Line	:
City	:	HADDONFIELD
State	:	NJ
Zip	:	08033-2316
Country	:	US
Telephone Number	:	844-542-2273
Fax Number	:	856-428-0702

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

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	10/20/2022

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