Provider Demographics
NPI:1174275655
Name:KIMBROUGH, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KIMBROUGH
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 1:3851 WYNN RD APT 1107
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-6018
Mailing Address - Country:US
Mailing Address - Phone:626-712-2338
Mailing Address - Fax:
Practice Address - Street 1:3851 WYNN RD APT 1107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-6018
Practice Address - Country:US
Practice Address - Phone:626-712-2338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider