Provider Demographics
NPI:1750555389
Name:HOWARD, KIMBERLY DIANA (PSC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DIANA
Last Name:HOWARD
Suffix:
Gender:F
Credentials:PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HENDRICKSON PASS
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-7117
Mailing Address - Country:US
Mailing Address - Phone:606-573-4544
Mailing Address - Fax:606-573-4544
Practice Address - Street 1:50 HENDRICKSON PASS
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-7117
Practice Address - Country:US
Practice Address - Phone:606-573-4544
Practice Address - Fax:606-573-4544
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02036171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator