Provider Demographics
NPI:1164540597
Name:HOLT, KIMBERLY SHAW LUMPKIN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SHAW LUMPKIN
Last Name:HOLT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 BARRACUDA COVE CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-4718
Mailing Address - Country:US
Mailing Address - Phone:443-370-9833
Mailing Address - Fax:
Practice Address - Street 1:113 DUKE OF GLOUCESTER ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2528
Practice Address - Country:US
Practice Address - Phone:410-990-4233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer