Provider Demographics
NPI:1417528613
Name:SKINNER, KIMBERLY R (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:SKINNER
Suffix:
Gender:F
Credentials:DPT
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 257
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:KS
Mailing Address - Zip Code:67867-0257
Mailing Address - Country:US
Mailing Address - Phone:620-846-0655
Mailing Address - Fax:
Practice Address - Street 1:401 CHEYENNE
Practice Address - Street 2:
Practice Address - City:SATANTA
Practice Address - State:KS
Practice Address - Zip Code:67870-8748
Practice Address - Country:US
Practice Address - Phone:620-649-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03285208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation