Provider Demographics
NPI:1467826172
Name:LONGMIRE, KIMBERLEY NICOLE (LACTATION COUNSELOR)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:NICOLE
Last Name:LONGMIRE
Suffix:
Gender:F
Credentials:LACTATION COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MICANOPY CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3532
Mailing Address - Country:US
Mailing Address - Phone:859-967-3020
Mailing Address - Fax:
Practice Address - Street 1:205 MICANOPY CT
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3532
Practice Address - Country:US
Practice Address - Phone:859-967-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist