Provider Demographics
NPI:1780814483
Name:STREETS, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:STREETS
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 1:943 N 550 E
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46391-9479
Mailing Address - Country:US
Mailing Address - Phone:704-267-3519
Mailing Address - Fax:
Practice Address - Street 1:943 N 550 E
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46391-9479
Practice Address - Country:US
Practice Address - Phone:704-267-3519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist