Provider Demographics
NPI:1245655851
Name:HARRIS, KIMBERLY DYAN (ND)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DYAN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DYAN
Other - Last Name:THOWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:143 N MCCORMICK ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2723
Mailing Address - Country:US
Mailing Address - Phone:928-277-7414
Mailing Address - Fax:
Practice Address - Street 1:143 N MCCORMICK ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2723
Practice Address - Country:US
Practice Address - Phone:928-277-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13-1393175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath