Provider Demographics
NPI:1821345745
Name:WILKINS, KIMBERLY B (BS BA CTCM)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:B
Last Name:WILKINS
Suffix:
Gender:F
Credentials:BS BA CTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 N BEACH ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-3314
Mailing Address - Country:US
Mailing Address - Phone:386-944-4707
Mailing Address - Fax:
Practice Address - Street 1:35 RIVER DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-4151
Practice Address - Country:US
Practice Address - Phone:386-846-9216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator