Provider Demographics
NPI:1366686750
Name:KIBBY, DAVONNA L
Entity Type:Individual
Prefix:MISS
First Name:DAVONNA
Middle Name:L
Last Name:KIBBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 BIDLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-5718
Mailing Address - Country:US
Mailing Address - Phone:614-271-1058
Mailing Address - Fax:
Practice Address - Street 1:3312 BIDLINGTON DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-5718
Practice Address - Country:US
Practice Address - Phone:614-271-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148690164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse