Provider Demographics
NPI:1548944176
Name:ANDERSON, KIMBERLY DONALDSON (MA - ED, IECE)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DONALDSON
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA - ED, IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 MERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-7642
Mailing Address - Country:US
Mailing Address - Phone:270-556-9561
Mailing Address - Fax:
Practice Address - Street 1:532 MERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-7642
Practice Address - Country:US
Practice Address - Phone:270-556-9561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19901475252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency