Provider Demographics
NPI:1356474712
Name:KIMMERLY, KAREN (AIDE)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:KIMMERLY
Suffix:
Gender:F
Credentials:AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HALE DR
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-8956
Mailing Address - Country:US
Mailing Address - Phone:937-544-5302
Mailing Address - Fax:
Practice Address - Street 1:70 HALE DR
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-8956
Practice Address - Country:US
Practice Address - Phone:937-544-5043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide