Provider Demographics
NPI:1033484274
Name:VESTER-COUCH, KIMBERLEY DAWN (LAC, DIPL OM, DOM)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:DAWN
Last Name:VESTER-COUCH
Suffix:
Gender:F
Credentials:LAC, DIPL OM, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S BROADWAY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3922
Mailing Address - Country:US
Mailing Address - Phone:316-285-8058
Mailing Address - Fax:
Practice Address - Street 1:505 S BROADWAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-3922
Practice Address - Country:US
Practice Address - Phone:316-285-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1054171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist