Provider Demographics
NPI:1366170946
Name:JARVIS, KIMBERLY D (QHMS)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:D
Last Name:JARVIS
Suffix:
Gender:F
Credentials:QHMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BEST ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4906
Mailing Address - Country:US
Mailing Address - Phone:937-673-6988
Mailing Address - Fax:937-223-8638
Practice Address - Street 1:51 BEST ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4906
Practice Address - Country:US
Practice Address - Phone:937-673-6988
Practice Address - Fax:937-673-6988
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health