Provider Demographics
NPI:1194260315
Name:BRADY, KIMALA
Entity type:Individual
Prefix:
First Name:KIMALA
Middle Name:
Last Name:BRADY
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 1:812 LIVE OAK DR STE D
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2621
Mailing Address - Country:US
Mailing Address - Phone:757-523-5464
Mailing Address - Fax:757-257-0351
Practice Address - Street 1:812 LIVE OAK DR STE D
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2621
Practice Address - Country:US
Practice Address - Phone:757-523-5464
Practice Address - Fax:757-257-0351
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health