Provider Demographics
NPI:1144553694
Name:CHERRY, KIMBERLY EVE (LAC,MAC,DIPLAC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:EVE
Last Name:CHERRY
Suffix:
Gender:F
Credentials:LAC,MAC,DIPLAC
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 591
Mailing Address - Street 2:
Mailing Address - City:SKIPPACK
Mailing Address - State:PA
Mailing Address - Zip Code:19474-0591
Mailing Address - Country:US
Mailing Address - Phone:610-584-2340
Mailing Address - Fax:610-584-2320
Practice Address - Street 1:4080 SKIPPACK PIKE
Practice Address - Street 2:
Practice Address - City:SKIPPACK
Practice Address - State:PA
Practice Address - Zip Code:19474
Practice Address - Country:US
Practice Address - Phone:610-584-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000971171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist