Provider Demographics
NPI:1710666714
Name:PRIDE, KIMBERLY LYNETTE
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LYNETTE
Last Name:PRIDE
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 1:1238 WYLEY AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-2851
Mailing Address - Country:US
Mailing Address - Phone:330-329-0117
Mailing Address - Fax:
Practice Address - Street 1:1238 WYLEY AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-2851
Practice Address - Country:US
Practice Address - Phone:330-329-0117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker