Provider Demographics
NPI:1972279883
Name:CALVIN, KIMBERLY DRIVER
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DRIVER
Last Name:CALVIN
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 1:2340 E TRINITY MILLS RD STE 111
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1900
Mailing Address - Country:US
Mailing Address - Phone:214-682-3169
Mailing Address - Fax:
Practice Address - Street 1:2340 E TRINITY MILLS RD STE 111
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1900
Practice Address - Country:US
Practice Address - Phone:214-682-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX020674225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist