Provider Demographics
NPI:1659088383
Name:KIMBROUGH, SHAKIMA SONYETTA
Entity Type:Individual
Prefix:
First Name:SHAKIMA
Middle Name:SONYETTA
Last Name:KIMBROUGH
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 1:1112 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-1739
Mailing Address - Country:US
Mailing Address - Phone:414-248-8680
Mailing Address - Fax:
Practice Address - Street 1:1112 W VINE ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1739
Practice Address - Country:US
Practice Address - Phone:414-248-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator