Provider Demographics
NPI:1417444183
Name:HART, KIMBERLY JOAN (CGC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOAN
Last Name:HART
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 S CONSTITUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-8600
Mailing Address - Country:US
Mailing Address - Phone:801-584-8256
Mailing Address - Fax:801-536-0966
Practice Address - Street 1:4431 S CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-8600
Practice Address - Country:US
Practice Address - Phone:801-584-8256
Practice Address - Fax:801-536-0966
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3083031-3601170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS