Provider Demographics
NPI:1316197213
Name:SHUPP, KIMBERLY A (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:SHUPP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:LAHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:661 TOWNSEN PL
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-8624
Mailing Address - Country:US
Mailing Address - Phone:513-623-9318
Mailing Address - Fax:
Practice Address - Street 1:532 MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2408
Practice Address - Country:US
Practice Address - Phone:513-559-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-090353164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse