| NPI | 1497298418 |
|---|---|
| Doing Business As | KIMBERLY WARD |
| Entity Type | Organization |
| Authorized Contact | KIMBERLY ANGELA WARD Caregiver 386-855-4836 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL 305R00000x) |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2016-11-22 |