Provider Demographics
NPI:1376600288
Name:LITTRELL, KIMBERLY HARRELL (APRN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:HARRELL
Last Name:LITTRELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 TUCKER DR
Mailing Address - Street 2:BLDG A
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4390
Mailing Address - Country:US
Mailing Address - Phone:770-554-8812
Mailing Address - Fax:770-554-9810
Practice Address - Street 1:2430 TUCKER DR
Practice Address - Street 2:BLDG A
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4390
Practice Address - Country:US
Practice Address - Phone:770-554-8812
Practice Address - Fax:770-554-9810
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN060422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA088901OtherVALUEOPTIONS UPIN
GA088901OtherVALUEOPTIONS UPIN