Provider Demographics
NPI:1366085524
Name:MORRISSETTE, KIMBERLY ARLISA
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ARLISA
Last Name:MORRISSETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ARLISAS
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6288 LETSON FARMS DR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-7023
Mailing Address - Country:US
Mailing Address - Phone:205-523-5664
Mailing Address - Fax:
Practice Address - Street 1:6288 LETSON FARMS DR
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-7023
Practice Address - Country:US
Practice Address - Phone:205-523-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor