Provider Demographics
NPI:1144398652
Name:PARSONS, KIMBERLY EXLER
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:EXLER
Last Name:PARSONS
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 1:18104 ZANZIBAR AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-1723
Mailing Address - Country:US
Mailing Address - Phone:941-276-1751
Mailing Address - Fax:941-766-7180
Practice Address - Street 1:18104 ZANZIBAR AVE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-1723
Practice Address - Country:US
Practice Address - Phone:941-276-1751
Practice Address - Fax:941-766-7180
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL682233996Medicaid
FL686203968Medicaid