Provider Demographics
NPI:1427611243
Name:CRABTREE-LOYD, KIMBERLEY MARIE (NPF)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:MARIE
Last Name:CRABTREE-LOYD
Suffix:
Gender:F
Credentials:NPF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-0717
Mailing Address - Country:US
Mailing Address - Phone:323-567-9782
Mailing Address - Fax:323-567-9784
Practice Address - Street 1:9401 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-4679
Practice Address - Country:US
Practice Address - Phone:323-567-9782
Practice Address - Fax:323-567-9784
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10415163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10415OtherCA NPF LICENSE