MEDICARE: KIMBERLY BYRD

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	372600000X	Adult Companion
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1972088557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BYRD

Provider Business Mailing Address
First Line	:	7853 BIRCH BRANCH TER
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22315-6129
Country	:	US
Telephone Number	:	210-313-8567
Fax Number	:

Provider Business Practice Location Address
First Line	:	15807 TAMPKE PL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5914
Country	:	US
Telephone Number	:	210-313-8567
Fax Number	:

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

Provider Enumeration Date	:	09/28/2018
Last Update Date	:	09/28/2018

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Directions to “ KIMBERLY BYRD ” Practice Location

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