Provider Demographics
NPI:1063666154
Name:FERN, KIMBERLY ANNE
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:FERN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:SERBU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 HERMAN SMITHERS RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-8773
Mailing Address - Country:US
Mailing Address - Phone:502-875-4690
Mailing Address - Fax:502-875-4690
Practice Address - Street 1:275 HERMAN SMITHERS RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-8773
Practice Address - Country:US
Practice Address - Phone:502-875-4690
Practice Address - Fax:502-875-4690
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-16
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker