Provider Demographics
NPI:1063955656
Name:KIMBROUGH, RISA
Entity type:Individual
Prefix:
First Name:RISA
Middle Name:
Last Name:KIMBROUGH
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:PO BOX 2276
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-9376
Mailing Address - Country:US
Mailing Address - Phone:609-442-9755
Mailing Address - Fax:
Practice Address - Street 1:350 BLACKWOOD CLEMENTON RD
Practice Address - Street 2:APT 702
Practice Address - City:PINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:08021-5243
Practice Address - Country:US
Practice Address - Phone:609-442-9755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health