Provider Demographics
NPI:1164544300
Name:WHITFIELD, KIM GREENE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:GREENE
Last Name:WHITFIELD
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 1:124 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-2237
Mailing Address - Country:US
Mailing Address - Phone:937-478-9501
Mailing Address - Fax:937-268-5258
Practice Address - Street 1:124 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-2237
Practice Address - Country:US
Practice Address - Phone:937-478-9501
Practice Address - Fax:937-268-5258
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2377468164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05Medicare UPIN