Provider Demographics
NPI:1366182370
Name:PERRINE, KIMBERLY A (CHC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:PERRINE
Suffix:
Gender:F
Credentials:CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13111 BAKER TRL
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5017
Mailing Address - Country:US
Mailing Address - Phone:161-232-3500
Mailing Address - Fax:952-888-1134
Practice Address - Street 1:7500 GOLDEN TRIANGLE DR UNIT G11
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3860
Practice Address - Country:US
Practice Address - Phone:612-323-5000
Practice Address - Fax:952-888-1134
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach