Provider Demographics
NPI:1902361249
Name:KISER, KIMBERLY DARA
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DARA
Last Name:KISER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13066 RIVER LN
Mailing Address - Street 2:
Mailing Address - City:COEBURN
Mailing Address - State:VA
Mailing Address - Zip Code:24230-5742
Mailing Address - Country:US
Mailing Address - Phone:276-275-9970
Mailing Address - Fax:276-807-7405
Practice Address - Street 1:13066 RIVER LN
Practice Address - Street 2:
Practice Address - City:COEBURN
Practice Address - State:VA
Practice Address - Zip Code:24230-5742
Practice Address - Country:US
Practice Address - Phone:276-275-9970
Practice Address - Fax:276-807-7405
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)