Provider Demographics
NPI:1225529126
Name:BARNES, KIMBERLY DENNIESE (OMD LAC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DENNIESE
Last Name:BARNES
Suffix:
Gender:F
Credentials:OMD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 E WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3226
Mailing Address - Country:US
Mailing Address - Phone:954-681-3100
Mailing Address - Fax:
Practice Address - Street 1:160 INTERNATIONAL PKWY STE 250-8
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5056
Practice Address - Country:US
Practice Address - Phone:954-681-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3938171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist