Provider Demographics
NPI:1164411468
Name:BROWN, KIMBERLY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:1368 E. HIGHWAY 192
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-1359
Mailing Address - Country:US
Mailing Address - Phone:606-864-6680
Mailing Address - Fax:606-864-7310
Practice Address - Street 1:1368 HIGHWAY 192 E
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3123
Practice Address - Country:US
Practice Address - Phone:606-864-6680
Practice Address - Fax:606-864-7310
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5821223P0221X
KY6688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45605607Medicaid
KY60066883Medicaid