Provider Demographics
NPI:1114482627
Name:DUCLOS, KIMBERLY RACHELLE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RACHELLE
Last Name:DUCLOS
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 1:5000 SW 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3614
Mailing Address - Country:US
Mailing Address - Phone:954-536-0834
Mailing Address - Fax:
Practice Address - Street 1:5000 SW 150TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3614
Practice Address - Country:US
Practice Address - Phone:954-536-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider