Provider Demographics
NPI:1033530050
Name:MARTIN, KIMBERLY KENNEDY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KENNEDY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 SKYE DR
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-8051
Mailing Address - Country:US
Mailing Address - Phone:843-259-0737
Mailing Address - Fax:
Practice Address - Street 1:158 SKYE DR
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-8051
Practice Address - Country:US
Practice Address - Phone:843-259-0737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist