Provider Demographics
NPI:1568803633
Name:PITKIN, KIMBERLY ANN (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:PITKIN
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:PO BOX 587
Mailing Address - Street 2:2178 EAST SENECA STREET
Mailing Address - City:OVID
Mailing Address - State:NY
Mailing Address - Zip Code:14521-0587
Mailing Address - Country:US
Mailing Address - Phone:607-227-8847
Mailing Address - Fax:
Practice Address - Street 1:2178 EAST SENECA STREET
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:NY
Practice Address - Zip Code:14521
Practice Address - Country:US
Practice Address - Phone:607-227-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223542-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse