Provider Demographics
NPI:1518624709
Name:KIMBERLY PERSAUD
Entity Type:Organization
Organization Name:KIMBERLY PERSAUD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:KELLY BROOKS
Authorized Official - Prefix:
Authorized Official - First Name:CAPELLA
Authorized Official - Middle Name:UNIVERSITY
Authorized Official - Last Name:1053078444
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:612-977-5000
Mailing Address - Street 1:723 ESSEX ST PH
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4407
Mailing Address - Country:US
Mailing Address - Phone:347-600-9463
Mailing Address - Fax:
Practice Address - Street 1:225 S 6TH ST STE 9
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-4643
Practice Address - Country:US
Practice Address - Phone:612-977-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)