Provider Demographics
NPI:1679679070
Name:BAGGETT, KIMBERLY LYN (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYN
Last Name:BAGGETT
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4096 SUMMERHILL SQUARE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503
Mailing Address - Country:US
Mailing Address - Phone:903-255-0307
Mailing Address - Fax:888-551-6612
Practice Address - Street 1:4096 SUMMERHILL SQUARE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503
Practice Address - Country:US
Practice Address - Phone:903-255-0307
Practice Address - Fax:888-551-6612
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX426571041C0700X, 104100000X
AR1897M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker