Provider Demographics
NPI:1619632114
Name:O'GRADY, KYMBERLI GAYLE (RN)
Entity Type:Individual
Prefix:
First Name:KYMBERLI
Middle Name:GAYLE
Last Name:O'GRADY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KYMBERLI
Other - Middle Name:GAYLE
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:128 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3757
Mailing Address - Country:US
Mailing Address - Phone:321-258-8523
Mailing Address - Fax:
Practice Address - Street 1:30 HUNTER LN
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2400
Practice Address - Country:US
Practice Address - Phone:800-748-3243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH079353-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse