Provider Demographics
NPI:1639340268
Name:PATTERSON, KIMBERLY GEORGEANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:GEORGEANN
Last Name:PATTERSON
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 1:9727 ROCKY FORK RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43071-9781
Mailing Address - Country:US
Mailing Address - Phone:740-745-2652
Mailing Address - Fax:740-745-1219
Practice Address - Street 1:9727 ROCKY FORK RD
Practice Address - Street 2:
Practice Address - City:ST LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:43071-9781
Practice Address - Country:US
Practice Address - Phone:740-745-2652
Practice Address - Fax:740-745-1219
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.091994164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse