Provider Demographics
NPI:1811075849
Name:ALFORD, KIMBERLY A
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:ALFORD
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 1:1901 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-4347
Mailing Address - Country:US
Mailing Address - Phone:804-358-1874
Mailing Address - Fax:804-278-8977
Practice Address - Street 1:1901 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4347
Practice Address - Country:US
Practice Address - Phone:804-358-1874
Practice Address - Fax:804-278-8977
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001254225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192085Medicaid
VA4978013Medicaid
VA96110OtherSOUTHERN HEALTH
VA31752Medicaid
VA40463Medicaid
VI228875OtherOPTIMUM CHOICE
VA6400489OtherUNITED HEALTHCARE
VA7756200OtherAETNA
VA192085OtherANTHEM