Provider Demographics
NPI:1801211479
Name:BATY, KIMBERLY M (PC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:BATY
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-0459
Mailing Address - Country:US
Mailing Address - Phone:573-756-5749
Mailing Address - Fax:
Practice Address - Street 1:1051 KINGSHIGHWAY ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2938
Practice Address - Country:US
Practice Address - Phone:573-364-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013038293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional