Provider Demographics
NPI:1386820850
Name:DESMOND, KIMBERLY H (MS)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:H
Last Name:DESMOND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:HELEN
Other - Last Name:DESMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:8550 TOUCHTON RD APT 2236
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2237
Mailing Address - Country:US
Mailing Address - Phone:904-445-1622
Mailing Address - Fax:
Practice Address - Street 1:904 B BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250
Practice Address - Country:US
Practice Address - Phone:904-445-1622
Practice Address - Fax:904-293-1815
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0419231H00000X
FLAY2158231HA2500X, 237600000X, 231H00000X, 231H00000X
KYKY-0814237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102216900Medicaid
KY1861796302OtherBLUEGRASS AUDIOLOGY LLC
KY7100241380Medicaid