1295125854 NPI number — MRS. KIMBERLY ANNE HORTON CPHT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295125854 NPI number — MRS. KIMBERLY ANNE HORTON CPHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORTON
Provider First Name:
KIMBERLY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HORTON
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPHT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295125854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 CHARGE POND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAREHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02571-1115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-295-8774
Provider Business Mailing Address Fax Number:
508-273-0457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 CHARGE POND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAREHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02571-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-295-8774
Provider Business Practice Location Address Fax Number:
508-273-0457
Provider Enumeration Date:
02/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  PT11 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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