Provider Demographics
NPI:1639621618
Name:ARNOLD, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:ARNOLD
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 1:50 WILLIAMSTOWNE CT
Mailing Address - Street 2:APT 8
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-3916
Mailing Address - Country:US
Mailing Address - Phone:716-768-5587
Mailing Address - Fax:
Practice Address - Street 1:50 WILLIAMSTOWNE CT
Practice Address - Street 2:APT 8
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-3916
Practice Address - Country:US
Practice Address - Phone:716-768-5587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268970164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse