Provider Demographics
NPI:1467755116
Name:LEMMONS, KIMBERLEY JOY (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:JOY
Last Name:LEMMONS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 VANDERCOOK WAY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4024
Mailing Address - Country:US
Mailing Address - Phone:360-430-7483
Mailing Address - Fax:
Practice Address - Street 1:1113 VANDERCOOK WAY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4024
Practice Address - Country:US
Practice Address - Phone:360-430-7483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60197248225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist