Provider Demographics
NPI:1033707690
Name:ALDRIDGE, KYMBERLY
Entity Type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:
Last Name:ALDRIDGE
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 1:74 RAVENS LN
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-1533
Mailing Address - Country:US
Mailing Address - Phone:304-813-8988
Mailing Address - Fax:
Practice Address - Street 1:74 RAVENS LN
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-1533
Practice Address - Country:US
Practice Address - Phone:304-813-8988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator