Provider Demographics
NPI:1427178136
Name:CASTANEDA, KIMBERLY SAYLOR (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SAYLOR
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:IRIS
Other - Last Name:SAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:637 VONBRYAN TRCE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2138
Mailing Address - Country:US
Mailing Address - Phone:859-797-3998
Mailing Address - Fax:
Practice Address - Street 1:520 E MAXWELL ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-6432
Practice Address - Country:US
Practice Address - Phone:859-233-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical