Provider Demographics
NPI:1689225666
Name:SEARLES, KIMBERLY (LPN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:SEARLES
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 1:8452 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SODUS
Mailing Address - State:NY
Mailing Address - Zip Code:14551-9569
Mailing Address - Country:US
Mailing Address - Phone:315-398-1433
Mailing Address - Fax:
Practice Address - Street 1:8452 RIDGE RD
Practice Address - Street 2:
Practice Address - City:SODUS
Practice Address - State:NY
Practice Address - Zip Code:14551-9569
Practice Address - Country:US
Practice Address - Phone:315-398-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-22
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244011-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse