Provider Demographics
NPI:1023515608
Name:RAGLIN, KIMBERLY KAY (LVN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KAY
Last Name:RAGLIN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:KAY
Other - Last Name:RAGLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BRUMFIELD
Mailing Address - Street 1:704 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:VAN
Mailing Address - State:TX
Mailing Address - Zip Code:75790-2966
Mailing Address - Country:US
Mailing Address - Phone:903-368-0935
Mailing Address - Fax:
Practice Address - Street 1:704 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:VAN
Practice Address - State:TX
Practice Address - Zip Code:75790-2966
Practice Address - Country:US
Practice Address - Phone:903-368-0935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327746164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse