Provider Demographics
NPI:1326008400
Name:FARMER, KIMBERLEY JANET (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:JANET
Last Name:FARMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KAITLIN DR
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-6845
Mailing Address - Country:US
Mailing Address - Phone:702-374-3588
Mailing Address - Fax:601-815-0434
Practice Address - Street 1:2041 GEORGIA AVE NW STE 3400
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-1481
Practice Address - Country:US
Practice Address - Phone:202-865-1164
Practice Address - Fax:202-865-7407
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND19544207V00000X
MEMD26974207V00000X
MN73570207V00000X
NV12233207V00000X
MDD0083743207V00000X
ARE3463207V00000X
DCMD045442207V00000X
MS25217207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1326008400Medicaid
MS01709774Medicaid
AR149272001Medicaid
AR5M423Medicare ID - Type Unspecified
ARH74931Medicare UPIN
NVHN0512Medicare PIN