Individual
KIMBERLY C MAYROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1650 W OAK ST STE 200, ZIONSVILLE, IN 46077-3836
(317) 912-1399
(765) 680-0468
Mailing address
2705 N LEBANON ST STE 305, LEBANON, IN 46052-8622
(765) 485-8852
(765) 485-8669
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01054989
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200815790
—
IN
Enumeration date
05/19/2006
Last updated
07/21/2022
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