Provider Demographics
NPI:1073726758
Name:JUSTICE, KIMBERLY SUE
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SUE
Last Name:JUSTICE
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 1:56 COUNTY RD. 8
Mailing Address - Street 2:
Mailing Address - City:KITTS HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45645
Mailing Address - Country:US
Mailing Address - Phone:740-643-2933
Mailing Address - Fax:
Practice Address - Street 1:56 COUNTY RD. 8
Practice Address - Street 2:
Practice Address - City:KITTS HILL
Practice Address - State:OH
Practice Address - Zip Code:45645
Practice Address - Country:US
Practice Address - Phone:740-643-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2186012OtherINDEPENDENT PROVIDER