Provider Demographics
NPI:1689905945
Name:EDMOND, KIMBERLY (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:EDMOND
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 1:918 STERLING PL
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-1616
Mailing Address - Country:US
Mailing Address - Phone:631-671-1125
Mailing Address - Fax:
Practice Address - Street 1:400 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3229
Practice Address - Country:US
Practice Address - Phone:631-439-3091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291353164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse