Provider Demographics
NPI:1619305885
Name:DALY, KIMBERLY (LM, CPM)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:DALY
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 SUMMER BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76262-4929
Mailing Address - Country:US
Mailing Address - Phone:214-563-7410
Mailing Address - Fax:
Practice Address - Street 1:1406 SUMMER BREEZE CT
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76262-4929
Practice Address - Country:US
Practice Address - Phone:214-563-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99184176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife