Provider Demographics
NPI:1073234696
Name:MCKAY, KIMBERLY EDEN
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:EDEN
Last Name:MCKAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 UNIVERSITY AVE LOT 25
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3099
Mailing Address - Country:US
Mailing Address - Phone:701-721-4350
Mailing Address - Fax:
Practice Address - Street 1:2600 UNIVERSITY AVE LOT 25
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3099
Practice Address - Country:US
Practice Address - Phone:701-721-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care