1912960279 NPI number — KIMBERLY A AYERS-BRINGHURST RD

Table of content: KIMBERLY A AYERS-BRINGHURST RD (NPI 1912960279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912960279 NPI number — KIMBERLY A AYERS-BRINGHURST RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYERS-BRINGHURST
Provider First Name:
KIMBERLY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAMPBELL
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912960279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5445 LANARK RD STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTER VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18034-8694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-526-7300
Provider Business Mailing Address Fax Number:
833-204-9606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5425 LANARK RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTER VALLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18034-8697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-658-2788
Provider Business Practice Location Address Fax Number:
484-822-6145
Provider Enumeration Date:
04/08/2006

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: 133V00000X , with the licence number:  DN003176 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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