Provider Demographics
NPI:1356562292
Name:MINGUS, KIMBERLEY FAITH
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:FAITH
Last Name:MINGUS
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 1:828 MCINTOSH RD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-9345
Mailing Address - Country:US
Mailing Address - Phone:307-754-3331
Mailing Address - Fax:307-754-2459
Practice Address - Street 1:828 MCINTOSH RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-9345
Practice Address - Country:US
Practice Address - Phone:307-754-3331
Practice Address - Fax:307-754-2459
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services