Provider Demographics
NPI:1457859480
Name:MCNAMARA, KIMBERLY ANN (MS, LAT, ATC, NREMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:MS, LAT, ATC, NREMT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:BUCKHOLTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAT, ATC, NREMT
Mailing Address - Street 1:100 COCONUT GROVE DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2316
Mailing Address - Country:US
Mailing Address - Phone:802-735-7689
Mailing Address - Fax:
Practice Address - Street 1:400 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-8707
Practice Address - Country:US
Practice Address - Phone:802-735-7689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer