Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301016841 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301016841 | MI |
NPI | 1003368366 |
---|---|
Provider Name | Kimberley Ann Nash |
First Address | Brownstown, MI 48193-8317 |
Second Address | Brownstown, MI 48193-8317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2016 |
Last Update Date | 02/11/2016 |