Provider Demographics
NPI:1619294063
Name:FOUT, KIMBERLY SHAWN (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SHAWN
Last Name:FOUT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9532 CAMP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-9544
Mailing Address - Country:US
Mailing Address - Phone:740-289-1067
Mailing Address - Fax:937-386-2867
Practice Address - Street 1:9532 CAMP CREEK RD
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-9544
Practice Address - Country:US
Practice Address - Phone:740-289-1067
Practice Address - Fax:937-386-2867
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN259287163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse