Provider Demographics
NPI:1356014294
Name:PIKETT, KIMBERLY JANEL (CNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JANEL
Last Name:PIKETT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-0502
Mailing Address - Country:US
Mailing Address - Phone:267-992-2708
Mailing Address - Fax:
Practice Address - Street 1:227 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-3159
Practice Address - Country:US
Practice Address - Phone:267-992-2708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2021704383376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide