Provider Demographics
NPI:1356230437
Name:KIM, JO ANN (RN, PHD, CDCES)
Entity type:Individual
Prefix:
First Name:JO ANN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:RN, PHD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-8714
Mailing Address - Country:US
Mailing Address - Phone:605-202-1410
Mailing Address - Fax:
Practice Address - Street 1:222 CREEK DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-8714
Practice Address - Country:US
Practice Address - Phone:605-202-1410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN764248163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator