Provider Demographics
NPI:1093251555
Name:TIMMONS, KIMBERLY ANN
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:TIMMONS
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 1:1155 YEARSLEY DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4358
Mailing Address - Country:US
Mailing Address - Phone:302-399-3349
Mailing Address - Fax:
Practice Address - Street 1:1000 MIDWAY DR
Practice Address - Street 2:SUITE 11A
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952-2448
Practice Address - Country:US
Practice Address - Phone:302-682-7975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT-0004103225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE468417Medicare PIN