Provider Demographics
NPI:1609490341
Name:STEVENSON, KIMBERLY KAYE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAYE
Last Name:STEVENSON
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 1:1914 NW COPPER OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-8300
Mailing Address - Country:US
Mailing Address - Phone:816-330-5039
Mailing Address - Fax:816-988-4910
Practice Address - Street 1:1914 NW COPPER OAKS CIR
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-8300
Practice Address - Country:US
Practice Address - Phone:816-330-5039
Practice Address - Fax:816-988-4910
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy