Provider Demographics
NPI:1508610833
Name:WHITTINGTON, KIMBERLY (CPRS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WHITTINGTON
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:PACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-5144
Mailing Address - Country:US
Mailing Address - Phone:937-300-7313
Mailing Address - Fax:
Practice Address - Street 1:1100 SALEM AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-5144
Practice Address - Country:US
Practice Address - Phone:937-300-7313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS004860175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist