Provider Demographics
NPI:1215401971
Name:MULLIKIN, KIMBERLY MARIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:MULLIKIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 E LAMOKA AVE
Mailing Address - Street 2:
Mailing Address - City:SAVONA
Mailing Address - State:NY
Mailing Address - Zip Code:14879-9714
Mailing Address - Country:US
Mailing Address - Phone:607-527-9800
Mailing Address - Fax:607-527-9866
Practice Address - Street 1:64 E LAMOKA AVE
Practice Address - Street 2:
Practice Address - City:SAVONA
Practice Address - State:NY
Practice Address - Zip Code:14879-9714
Practice Address - Country:US
Practice Address - Phone:607-527-9800
Practice Address - Fax:607-527-9866
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY370160163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool