Provider Demographics
NPI:1316424237
Name:KIMBERLIN, CODY RAY
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:RAY
Last Name:KIMBERLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3592 HIGHWAY 26 W
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-8391
Mailing Address - Country:US
Mailing Address - Phone:501-625-0505
Mailing Address - Fax:
Practice Address - Street 1:408 N 1ST ST STE C
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:AR
Practice Address - Zip Code:71943-9252
Practice Address - Country:US
Practice Address - Phone:870-356-7404
Practice Address - Fax:870-825-2060
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator