Provider Demographics
NPI:1497928675
Name:KIMANI, NELLIUS W
Entity Type:Individual
Prefix:
First Name:NELLIUS
Middle Name:W
Last Name:KIMANI
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 1:2110 SANDSTONE CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5054
Mailing Address - Country:US
Mailing Address - Phone:817-899-4406
Mailing Address - Fax:817-453-1670
Practice Address - Street 1:2110 SANDSTONE CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5054
Practice Address - Country:US
Practice Address - Phone:817-899-4406
Practice Address - Fax:817-453-1670
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health