Provider Demographics
NPI:1710013594
Name:MYERS, KIMBERLY ANN (WSC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:MYERS
Suffix:
Gender:F
Credentials:WSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10833 HOFFNER EDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-4058
Mailing Address - Country:US
Mailing Address - Phone:813-672-6348
Mailing Address - Fax:813-672-0831
Practice Address - Street 1:10833 HOFFNER EDGE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-4058
Practice Address - Country:US
Practice Address - Phone:813-672-6348
Practice Address - Fax:813-672-0831
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker