Provider Demographics
NPI:1174818579
Name:TEMPLE, KIMBERLY A (APRN, CCNS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:APRN, CCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 W 3RD ST
Mailing Address - Street 2:SURGERY (112)
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45428-9000
Mailing Address - Country:US
Mailing Address - Phone:937-268-6511
Mailing Address - Fax:937-267-3991
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:SURGERY (112)
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:937-267-3991
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN234672-COA1COA1067364SA2200X
OHRN.234672-COA1 COA.1364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health