Provider Demographics
NPI:1518272186
Name:ROSSETTI, KIMBERLY KILLOUGH (LPN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:KILLOUGH
Last Name:ROSSETTI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8066 WILDFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-5620
Mailing Address - Country:US
Mailing Address - Phone:330-417-7656
Mailing Address - Fax:
Practice Address - Street 1:8066 WILDFLOWER LN
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-5620
Practice Address - Country:US
Practice Address - Phone:330-417-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2010-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 132017-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse