Provider Demographics
NPI:1821716663
Name:FARR, KIMBERLY (CPM, LM)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:FARR
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 ROAD RUNNER DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3383
Mailing Address - Country:US
Mailing Address - Phone:812-603-6016
Mailing Address - Fax:
Practice Address - Street 1:509 ROAD RUNNER DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-3383
Practice Address - Country:US
Practice Address - Phone:812-603-6016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99495176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife