Provider Demographics
NPI:1407627318
Name:MABRY, KIMBERLY (CERTIFIED HEALTH COA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:MABRY
Suffix:
Gender:F
Credentials:CERTIFIED HEALTH COA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24674 MANILA ROAD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301
Mailing Address - Country:US
Mailing Address - Phone:660-619-0981
Mailing Address - Fax:
Practice Address - Street 1:24674 MANILA ROAD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301
Practice Address - Country:US
Practice Address - Phone:660-619-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach