Provider Demographics
NPI:1215513528
Name:LEVEILLE, KIMBERLY CARLISLE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CARLISLE
Last Name:LEVEILLE
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 1:2810 MAYO ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-5646
Mailing Address - Country:US
Mailing Address - Phone:786-656-2711
Mailing Address - Fax:
Practice Address - Street 1:2810 MAYO ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-5646
Practice Address - Country:US
Practice Address - Phone:786-656-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide