Provider Demographics
NPI:1205429032
Name:NETLING, KIMBERLY KAY (DOM)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:NETLING
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32961-0280
Mailing Address - Country:US
Mailing Address - Phone:772-774-7775
Mailing Address - Fax:772-264-3181
Practice Address - Street 1:87 ROYAL PALM PT
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4253
Practice Address - Country:US
Practice Address - Phone:772-774-7775
Practice Address - Fax:772-264-3183
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4224171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist