Provider Demographics
NPI:1427599687
Name:WOOLLARD, KIMBERLY (CNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WOOLLARD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12380 PLAZA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12380 PLAZA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1043
Practice Address - Country:US
Practice Address - Phone:216-898-8488
Practice Address - Fax:216-362-0677
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily