Provider Demographics
NPI:1285857318
Name:JONES, KIM RAE (EMT)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:RAE
Last Name:JONES
Suffix:
Gender:F
Credentials:EMT
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:RAE
Other - Last Name:SEVERTSON-BREHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMT
Mailing Address - Street 1:768 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619
Mailing Address - Country:US
Mailing Address - Phone:530-621-6290
Mailing Address - Fax:530-295-2532
Practice Address - Street 1:768 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619
Practice Address - Country:US
Practice Address - Phone:530-621-6290
Practice Address - Fax:530-295-2532
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health