Provider Demographics
NPI:1346476983
Name:EVERSON, KIMBERLY H (DVM)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:H
Last Name:EVERSON
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8545 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:VAN DYNE
Mailing Address - State:WI
Mailing Address - Zip Code:54979-9723
Mailing Address - Country:US
Mailing Address - Phone:920-923-6608
Mailing Address - Fax:920-322-0384
Practice Address - Street 1:N8545 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:VAN DYNE
Practice Address - State:WI
Practice Address - Zip Code:54979-9723
Practice Address - Country:US
Practice Address - Phone:920-923-6608
Practice Address - Fax:920-322-0384
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6012-050174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian