Provider Demographics
NPI:1316752256
Name:JAY, KIMBERLY JEAN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JEAN
Last Name:JAY
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 1:4146 DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3105
Mailing Address - Country:US
Mailing Address - Phone:308-380-4503
Mailing Address - Fax:
Practice Address - Street 1:4146 DRIFTWOOD DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3105
Practice Address - Country:US
Practice Address - Phone:308-380-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor