Individual
MRS. KIM MACHELLE REMINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13251 MAIN STREET, MAYER, AZ 86333
(928) 632-8376
Mailing address
PO BOX 1109, MAYER, AZ 86333-1109
(928) 632-8376
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
820888
AHCCCS
AZ
Enumeration date
12/12/2006
Last updated
07/08/2007
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