Provider Demographics
NPI:1982965372
Name:LAYNE, KIMBERLY JANE (LAC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JANE
Last Name:LAYNE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 SOUTHPORT DR
Mailing Address - Street 2:#145
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7791
Mailing Address - Country:US
Mailing Address - Phone:602-743-0023
Mailing Address - Fax:
Practice Address - Street 1:4419 FRONTIER TRL
Practice Address - Street 2:SUITE 106
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1686
Practice Address - Country:US
Practice Address - Phone:602-743-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-03
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
TXAC01357171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133N00000XDietary & Nutritional Service ProvidersNutritionist