Provider Demographics
NPI:1881489219
Name:STONECYPHER, KIMBERLY BROOKE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BROOKE
Last Name:STONECYPHER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 571
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-0571
Mailing Address - Country:US
Mailing Address - Phone:270-858-5377
Mailing Address - Fax:270-500-2212
Practice Address - Street 1:145 W STEVE WARINER DR
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4541
Practice Address - Country:US
Practice Address - Phone:270-858-5377
Practice Address - Fax:270-500-2212
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY260108101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health