Provider Demographics
NPI:1275863094
Name:TIMMONS, KAYMO
Entity Type:Individual
Prefix:
First Name:KAYMO
Middle Name:
Last Name:TIMMONS
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 1:183 ROCKY RDG
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-8850
Mailing Address - Country:US
Mailing Address - Phone:802-227-7255
Mailing Address - Fax:
Practice Address - Street 1:183 ROCKY RDG
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-8850
Practice Address - Country:US
Practice Address - Phone:802-227-7255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health