Individual
MRS. KIMBERLY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
204 LOWE AVE SE STE 2, HUNTSVILLE, AL 35801-4242
(256) 534-7235
Mailing address
3118 MALLARD POINT DR SE, OWENS CROSS ROADS, AL 35763-8497
(256) 679-3281
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
1-069756
AL
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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