Provider Demographics
NPI:1144895780
Name:WALTHOUR, KIMBERLYN JONES
Entity type:Individual
Prefix:
First Name:KIMBERLYN
Middle Name:JONES
Last Name:WALTHOUR
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 1:3801 HIGHPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-6004
Mailing Address - Country:US
Mailing Address - Phone:762-224-2993
Mailing Address - Fax:
Practice Address - Street 1:4210 COLUMBIA RD STE 2D
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0437
Practice Address - Country:US
Practice Address - Phone:762-224-2993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GURN155963163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical