Provider Demographics
NPI:1326733023
Name:KIMBER, STACEY Y (LMY)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:Y
Last Name:KIMBER
Suffix:
Gender:F
Credentials:LMY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3650
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-0650
Mailing Address - Country:US
Mailing Address - Phone:205-332-2868
Mailing Address - Fax:
Practice Address - Street 1:146 RIVER SQUARE PLZ
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-1667
Practice Address - Country:US
Practice Address - Phone:205-997-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6035225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist