1861247629 NPI number — KIMBERLY CHAMPION PSYD

Table of content: KIMBERLY CHAMPION PSYD (NPI 1861247629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861247629 NPI number — KIMBERLY CHAMPION PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAMPION
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAMPION
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
KIMBERLY CRAWFORD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861247629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
152 MARYLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST MIFFLIN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15122-4027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-708-0247
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2345 MURRAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15217-2352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-437-8298
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)