Provider Demographics
NPI:1750915237
Name:GARRY, KIMBERLY KELLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KELLY
Last Name:GARRY
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 1:2389 BATES AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-3928
Mailing Address - Country:US
Mailing Address - Phone:352-455-2391
Mailing Address - Fax:352-589-5109
Practice Address - Street 1:2389 BATES AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3928
Practice Address - Country:US
Practice Address - Phone:352-455-2391
Practice Address - Fax:352-589-5109
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)