Provider Demographics
NPI:1124026497
Name:HEROUX, KIMBERLY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:HEROUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 S STATE ROAD 7
Mailing Address - Street 2:#450
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9325
Mailing Address - Country:US
Mailing Address - Phone:561-798-1233
Mailing Address - Fax:
Practice Address - Street 1:4495 MILITARY TRL
Practice Address - Street 2:#101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4839
Practice Address - Country:US
Practice Address - Phone:561-799-3722
Practice Address - Fax:561-799-3692
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96455207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276148300Medicaid
FL276148300Medicaid
FLAG129YMedicare PIN