Provider Demographics
NPI:1013550219
Name:CHILCOTE, KIMBERLEY (LACTATION CONSULTANT)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:CHILCOTE
Suffix:
Gender:F
Credentials:LACTATION CONSULTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 LONE TREE WAY FL CENTER2
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6200
Mailing Address - Country:US
Mailing Address - Phone:925-202-6630
Mailing Address - Fax:
Practice Address - Street 1:3901 LONE TREE WAY FL 2
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6200
Practice Address - Country:US
Practice Address - Phone:925-779-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA377397163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant