Provider Demographics
NPI:1386230282
Name:COLE, KIMBERLEY A
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:A
Last Name:COLE
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 1:1024 TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1707
Mailing Address - Country:US
Mailing Address - Phone:614-804-7117
Mailing Address - Fax:
Practice Address - Street 1:1024 TIFFANY DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1707
Practice Address - Country:US
Practice Address - Phone:614-804-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide