Provider Demographics
NPI:1689391781
Name:MCCULLOUGH, KIMBERLY (OBAT NAVIGATOR)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:OBAT NAVIGATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E REDMAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2316
Mailing Address - Country:US
Mailing Address - Phone:844-542-2273
Mailing Address - Fax:856-428-0702
Practice Address - Street 1:15 E REDMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2316
Practice Address - Country:US
Practice Address - Phone:844-542-2273
Practice Address - Fax:856-428-0702
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator