Provider Demographics
NPI:1811122138
Name:PAISLEY, KIM REAVES (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:REAVES
Last Name:PAISLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 COUNTY ROAD 304
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-6900
Mailing Address - Country:US
Mailing Address - Phone:205-668-0626
Mailing Address - Fax:205-668-4564
Practice Address - Street 1:206 COUNTY ROAD 304
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-6900
Practice Address - Country:US
Practice Address - Phone:205-668-0626
Practice Address - Fax:205-668-4564
Is Sole Proprietor?:No
Enumeration Date:2009-05-17
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32719207R00000X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program