Provider Demographics
NPI:1033866652
Name:ROSS, KIMBERLY L
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4134 CALISPEL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:WV
Mailing Address - Zip Code:25123-6698
Mailing Address - Country:US
Mailing Address - Phone:304-812-8173
Mailing Address - Fax:
Practice Address - Street 1:4134 CALISPEL RIDGE RD
Practice Address - Street 2:
Practice Address - City:LEON
Practice Address - State:WV
Practice Address - Zip Code:25123-6698
Practice Address - Country:US
Practice Address - Phone:304-812-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant