Provider Demographics
NPI:1689273443
Name:STEPHENS, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:STEPHENS
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 1:11951 POPLAR CREEK RD NW
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43105-9361
Mailing Address - Country:US
Mailing Address - Phone:614-207-2231
Mailing Address - Fax:
Practice Address - Street 1:11951 POPLAR CREEK RD NW
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:43105-9361
Practice Address - Country:US
Practice Address - Phone:614-207-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker