Provider Demographics
NPI:1861741274
Name:SWAISLAND, KIMBERLY CHRISTIAN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CHRISTIAN
Last Name:SWAISLAND
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 1:1513 PEDIATRIC DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-4059
Mailing Address - Country:US
Mailing Address - Phone:205-221-4780
Mailing Address - Fax:205-221-4783
Practice Address - Street 1:1513 PEDIATRIC DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-4059
Practice Address - Country:US
Practice Address - Phone:205-221-4780
Practice Address - Fax:205-221-4783
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-129166363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics