Basic Information
| Provider Information | |||||||||
| NPI: | 1821082512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORBES | ||||||||
| FirstName: | KIMBALL | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MCD FAAA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1490 E FOREMASTER DR | ||||||||
| Address2: | STE 360 | ||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847904488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356888866 | ||||||||
| FaxNumber: | 4356882882 | ||||||||
| Practice Location | |||||||||
| Address1: | 1490 E FOREMASTER DR | ||||||||
| Address2: | STE 360 | ||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847904488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356888866 | ||||||||
| FaxNumber: | 4356882882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 10/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 1090604101 | UT | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.