Provider Demographics
NPI:1215669932
Name:JAREST, KIMBERLY ANN (IBCLC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:JAREST
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 PINE MEADOWS CIR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03442-4506
Mailing Address - Country:US
Mailing Address - Phone:603-933-0997
Mailing Address - Fax:
Practice Address - Street 1:31 PINE MEADOWS CIR
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NH
Practice Address - Zip Code:03442-4506
Practice Address - Country:US
Practice Address - Phone:603-933-0997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHL-307697174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN