Provider Demographics
NPI:1912029554
Name:HOUSER, KIMBERLY R
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:R
Last Name:HOUSER
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 1:3001 CHERRYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-1857
Mailing Address - Country:US
Mailing Address - Phone:765-529-4850
Mailing Address - Fax:765-529-1466
Practice Address - Street 1:3001 CHERRYWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-1857
Practice Address - Country:US
Practice Address - Phone:765-529-4850
Practice Address - Fax:765-529-1466
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN757241373H00000X
IN222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN373H00000XOtherTAXONOMY
IN200608040OtherRENDERING PHYSICIAN
IN200707390OtherPROVIDER NUMBER