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NPI Code Detail

MEDICARE: KIMBERLY DUDLEY BS, MBM, MS

MEDICARE: KIMBERLY DUDLEY BS, MBM, 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
1101Y00000XCounselor

General Provider Information

NPI Number : 1780954610
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY DUDLEY BS, MBM, MS
Provider Business Mailing Address
First Line : 4300 SW 13TH ST
Second Line :
City : GAINESVILLE
State : FL
Zip : 32608-4006
Country : US
Telephone Number : 352-374-5600
Fax Number :
Provider Business Practice Location Address
First Line : 945 GRAND ST
Second Line :
City : STARKE
State : FL
Zip : 32091-1821
Country : US
Telephone Number : 352-374-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2012
Last Update Date : 10/09/2018

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