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NPI Code Detail

MEDICARE: MS. KIMBERLY JUSTINE HERRMANN RDH

MEDICARE: MS. KIMBERLY JUSTINE HERRMANN RDH
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
1124Q00000XDental Hygienist2152-86DHMS

General Provider Information

NPI Number : 1932335635
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY JUSTINE HERRMANN RDH
Provider Business Mailing Address
First Line : 50 52ND ST
Second Line :
City : GULFPORT
State : MS
Zip : 39507-4519
Country : US
Telephone Number : 228-365-4488
Fax Number : 866-905-4316
Provider Business Practice Location Address
First Line : 2574 MARCIA CT
Second Line :
City : BILOXI
State : MS
Zip : 39531-2341
Country : US
Telephone Number : 228-388-9545
Fax Number : 228-385-1161
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2009
Last Update Date : 06/08/2009

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