Provider Demographics
NPI:1821971813
Name:KIMBROUGH, LASHAUNA NICOLE
Entity type:Individual
Prefix:
First Name:LASHAUNA
Middle Name:NICOLE
Last Name:KIMBROUGH
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 1:2271 SPARROW LN
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-1740
Mailing Address - Country:US
Mailing Address - Phone:850-480-8299
Mailing Address - Fax:
Practice Address - Street 1:923 PINE TOP LN
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-8469
Practice Address - Country:US
Practice Address - Phone:850-356-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant