Provider Demographics
NPI:1508630773
Name:DABNEY, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:DABNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15308 MOORES MILL RD
Mailing Address - Street 2:
Mailing Address - City:RUTHER GLEN
Mailing Address - State:VA
Mailing Address - Zip Code:22546-3714
Mailing Address - Country:US
Mailing Address - Phone:804-922-6878
Mailing Address - Fax:
Practice Address - Street 1:15308 MOORES MILL RD
Practice Address - Street 2:
Practice Address - City:RUTHER GLEN
Practice Address - State:VA
Practice Address - Zip Code:22546-3714
Practice Address - Country:US
Practice Address - Phone:804-922-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver