Provider Demographics
NPI:1003109018
Name:GAINEY, KIMBERLY CAROL (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CAROL
Last Name:GAINEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12263 BAUGHMAN ST SW
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:OH
Mailing Address - Zip Code:44662-9635
Mailing Address - Country:US
Mailing Address - Phone:330-933-5914
Mailing Address - Fax:
Practice Address - Street 1:12263 BAUGHMAN ST SW
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:OH
Practice Address - Zip Code:44662-9635
Practice Address - Country:US
Practice Address - Phone:330-933-5914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN131191164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse