Provider Demographics
NPI:1578223772
Name:RICHARDSONE, KIMBERLEE CHEYANN
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:CHEYANN
Last Name:RICHARDSONE
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 1:2150 25TH STREET NW
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881
Mailing Address - Country:US
Mailing Address - Phone:863-877-7376
Mailing Address - Fax:
Practice Address - Street 1:2150 25TH STREET NW
Practice Address - Street 2:APARTMENT A
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881
Practice Address - Country:US
Practice Address - Phone:863-877-7376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237765372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty