Provider Demographics
NPI:1508054115
Name:JARVIE, KIMBERLY S (CNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:JARVIE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:S
Other - Last Name:MYFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1500 EASTWAY DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44242-0001
Mailing Address - Country:US
Mailing Address - Phone:330-672-2322
Mailing Address - Fax:330-672-2272
Practice Address - Street 1:1500 EASTWAY DR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44242-0001
Practice Address - Country:US
Practice Address - Phone:330-672-2322
Practice Address - Fax:330-672-2272
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09677NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health