Provider Demographics
NPI:1245819978
Name:AMOS, KIMERLETHA L (BS)
Entity type:Individual
Prefix:
First Name:KIMERLETHA
Middle Name:L
Last Name:AMOS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4276A N 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1812
Mailing Address - Country:US
Mailing Address - Phone:414-975-5680
Mailing Address - Fax:
Practice Address - Street 1:4276 N 28TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1812
Practice Address - Country:US
Practice Address - Phone:414-975-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator