Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY 7064 | FL |
Y | 103T00000X | Psychologist | PY 7064 | FL |
NPI | 1003879537 |
---|---|
Provider Name | Dr. Kimberly Ann Kirkpatrick Justice |
First Address | Winter Park, FL 32789-1608 |
Second Address | Winter Park, FL 32789-3314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 08/07/2007 |