Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW383 | FL |
NPI | 1023494101 |
---|---|
Provider Name | Kimberley Homer |
First Address | Tallahassee, FL 32303-6612 |
Second Address | Tallahassee, FL 32303-6612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2015 |
Last Update Date | 13/09/2019 |