Provider Demographics
NPI:1710131396
Name:RETHERFORD, KIM S (LM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:S
Last Name:RETHERFORD
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 GANZER RD W
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-4467
Mailing Address - Country:US
Mailing Address - Phone:940-368-2401
Mailing Address - Fax:940-204-5588
Practice Address - Street 1:3170 GANZER RD W
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-4467
Practice Address - Country:US
Practice Address - Phone:940-368-2401
Practice Address - Fax:940-204-5588
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99064176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife