Provider Demographics
NPI:1447832845
Name:MCDONALD, KIMBERLY DENISE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DENISE
Last Name:MCDONALD
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 1:5150 E SAHARA AVE APT 262
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-2517
Mailing Address - Country:US
Mailing Address - Phone:702-504-5155
Mailing Address - Fax:
Practice Address - Street 1:5150 E SAHARA AVE APT 262
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-2517
Practice Address - Country:US
Practice Address - Phone:702-504-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCNA027615251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health