Provider Demographics
NPI:1659786432
Name:KIMBERLY WILKINS PSYD LLC
Entity Type:Organization
Organization Name:KIMBERLY WILKINS PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:417-844-3982
Mailing Address - Street 1:1344 W OAKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-1696
Mailing Address - Country:US
Mailing Address - Phone:417-844-3982
Mailing Address - Fax:417-881-0443
Practice Address - Street 1:1344 W OAKVILLE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-1696
Practice Address - Country:US
Practice Address - Phone:417-844-3982
Practice Address - Fax:417-881-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty