Provider Demographics
NPI:1548215262
Name:PARSONS, KIMBERLY DAWN (MA)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:PARSONS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:RAYBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1097 FLEDDERJOHN ROAD
Mailing Address - Street 2:STE 3
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314
Mailing Address - Country:US
Mailing Address - Phone:304-345-0880
Mailing Address - Fax:304-345-1112
Practice Address - Street 1:1097 FLEDDERJOHN ROAD
Practice Address - Street 2:STE 3
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314
Practice Address - Country:US
Practice Address - Phone:304-345-0880
Practice Address - Fax:304-345-1112
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV860103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV113713302003OtherMTN STATE BCBS
WV9202185000Medicaid
PA4129171Medicare ID - Type Unspecified