Provider Demographics
NPI:1659850063
Name:ALEXANDER, KIMBERLY MICHELLE (CAMS, CCIS, CDVS, PI)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:CAMS, CCIS, CDVS, PI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490B N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-4700
Mailing Address - Country:US
Mailing Address - Phone:731-798-5055
Mailing Address - Fax:731-968-0400
Practice Address - Street 1:1490B N BROAD ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-4700
Practice Address - Country:US
Practice Address - Phone:731-798-5055
Practice Address - Fax:731-968-0400
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist