Provider Demographics
NPI:1164128575
Name:EDOUARD, KEMBERLINE
Entity Type:Individual
Prefix:
First Name:KEMBERLINE
Middle Name:
Last Name:EDOUARD
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 1:1505 W THARPE ST APT 1311
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4543
Mailing Address - Country:US
Mailing Address - Phone:407-701-2596
Mailing Address - Fax:
Practice Address - Street 1:1505 W THARPE ST APT 1311
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4543
Practice Address - Country:US
Practice Address - Phone:407-701-2596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program