Provider Demographics
NPI:1932814373
Name:SLIMM, KELLI MICHELLE
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:MICHELLE
Last Name:SLIMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:MICHELLE
Other - Last Name:SLIMM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6215 BRAYDEN WAY
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-5335
Mailing Address - Country:US
Mailing Address - Phone:352-470-9950
Mailing Address - Fax:
Practice Address - Street 1:6215 BRAYDEN WAY
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-5335
Practice Address - Country:US
Practice Address - Phone:352-470-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula