Provider Demographics
NPI:1316117518
Name:MELLINGER, KIM SCHMIDT (PT)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:SCHMIDT
Last Name:MELLINGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KIM
Other - Middle Name:JACQUELINE
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:703 SILVER OAK CT
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-1945
Mailing Address - Country:US
Mailing Address - Phone:661-822-7676
Mailing Address - Fax:
Practice Address - Street 1:703 SILVER OAK CT
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1945
Practice Address - Country:US
Practice Address - Phone:661-822-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 13385174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist