Provider Demographics
NPI:1578349833
Name:KIMBLE, KIARA DANIELLE
Entity Type:Individual
Prefix:
First Name:KIARA
Middle Name:DANIELLE
Last Name:KIMBLE
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 1:892 S CABLE RD APT 104
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-3438
Mailing Address - Country:US
Mailing Address - Phone:734-828-9058
Mailing Address - Fax:
Practice Address - Street 1:892 S CABLE RD APT 104
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-3438
Practice Address - Country:US
Practice Address - Phone:734-828-9058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH322258821223376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide