Provider Demographics
NPI:1659045888
Name:PERSON, KIMBERLY (APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:PERSON
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:PERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12380 PLAZA DR
Mailing Address - Street 2:STE 101
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1043
Mailing Address - Country:US
Mailing Address - Phone:216-898-8488
Mailing Address - Fax:216-362-0677
Practice Address - Street 1:28100 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4522
Practice Address - Country:US
Practice Address - Phone:216-831-1466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily