Individual
MRS. TIFFANY KIMBROUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3980 SOUTH JACKSON DRIVE, INDEPENDENCE, MO 64057
(816) 478-5605
Mailing address
33909 E JENKINS RD, LONE JACK, MO 64070-9155
(816) 616-9566
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
2011015347
MO
Other
Enumeration date
10/19/2016
Last updated
10/19/2016
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