Provider Demographics
NPI:1821415423
Name:JERLES, KIMBERLEE DAWN (LMT)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLEE
Middle Name:DAWN
Last Name:JERLES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4187 ELDER CT
Mailing Address - Street 2:#15
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-9586
Mailing Address - Country:US
Mailing Address - Phone:859-282-8442
Mailing Address - Fax:
Practice Address - Street 1:3631 DECOURSEY AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-1436
Practice Address - Country:US
Practice Address - Phone:859-431-2273
Practice Address - Fax:859-431-6937
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 1766225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist