Provider Demographics
NPI:1679236392
Name:ADAMS, KIMBERLY J
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:ADAMS
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 1:11705 CHILLICOTHE LANCASTER RD SW
Mailing Address - Street 2:
Mailing Address - City:AMANDA
Mailing Address - State:OH
Mailing Address - Zip Code:43102-9538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11705 CHILLICOTHE LANCASTER RD SW
Practice Address - Street 2:
Practice Address - City:AMANDA
Practice Address - State:OH
Practice Address - Zip Code:43102-9538
Practice Address - Country:US
Practice Address - Phone:740-409-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.465436163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse