Provider Demographics
NPI:1316374424
Name:FERRIS, KIMBERLY (MS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:FERRIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 MOUNT VERNON ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2853
Mailing Address - Country:US
Mailing Address - Phone:203-727-7607
Mailing Address - Fax:
Practice Address - Street 1:167 MOUNT VERNON ST
Practice Address - Street 2:APT. 2
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-2853
Practice Address - Country:US
Practice Address - Phone:203-727-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program