Provider Demographics
NPI:1093228884
Name:CLAY, KIMBERLY JEAN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:CLAY
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 1:9735 LATTASBURG RD
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44287-9799
Mailing Address - Country:US
Mailing Address - Phone:330-641-2654
Mailing Address - Fax:
Practice Address - Street 1:9735 LATTASBURG RD
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:OH
Practice Address - Zip Code:44287-9799
Practice Address - Country:US
Practice Address - Phone:330-641-2654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN163400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse