Provider Demographics
NPI:1073572103
Name:OXLEY, KIMBERLY A (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:OXLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1642
Mailing Address - Country:US
Mailing Address - Phone:740-532-1188
Mailing Address - Fax:740-532-1183
Practice Address - Street 1:205 MARION PIKE
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-3165
Practice Address - Country:US
Practice Address - Phone:740-534-9195
Practice Address - Fax:740-532-1183
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073139208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2039369Medicaid
WV0111520000Medicaid
KY64960644Medicaid
OHG83120Medicare UPIN
KY64960644Medicaid
WV0111520000Medicaid