Provider Demographics
NPI:1336975275
Name:PLUMMER, KIMBERLY ANN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:PLUMMER
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 1:7150 QUAIL ST
Mailing Address - Street 2:
Mailing Address - City:FLORAHOME
Mailing Address - State:FL
Mailing Address - Zip Code:32140-6003
Mailing Address - Country:US
Mailing Address - Phone:251-533-8026
Mailing Address - Fax:
Practice Address - Street 1:2830 NW 41ST ST STE E
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6667
Practice Address - Country:US
Practice Address - Phone:352-262-9788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4022101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor