Provider Demographics
NPI:1689915290
Name:MYERS, KIM MARIE
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:MARIE
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:AMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:102 N MAIN ST
Mailing Address - Street 2:JAN & BEN'S HOME CARE
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1250
Mailing Address - Country:US
Mailing Address - Phone:585-593-3760
Mailing Address - Fax:
Practice Address - Street 1:5635 TAMARACK LN
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-9113
Practice Address - Country:US
Practice Address - Phone:607-346-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242094-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse