Provider Demographics
NPI:1699004135
Name:PHILLIPS, KIMBERLY CLARK (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CLARK
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9464 UNIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-9734
Mailing Address - Country:US
Mailing Address - Phone:614-332-0765
Mailing Address - Fax:614-873-2811
Practice Address - Street 1:9464 UNIONVILLE RD
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-9734
Practice Address - Country:US
Practice Address - Phone:614-332-0765
Practice Address - Fax:614-873-2811
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN365963163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN365963OtherOHIO BOARD OF NURSING