Provider Demographics
NPI:1760727457
Name:LYMON, KIMBERLY MONA (LPN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MONA
Last Name:LYMON
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 1:3243 W 41ST ST
Mailing Address - Street 2:UPSTAIRS
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1260
Mailing Address - Country:US
Mailing Address - Phone:216-255-7007
Mailing Address - Fax:
Practice Address - Street 1:3243 W 41ST ST
Practice Address - Street 2:UPSTAIRS
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1260
Practice Address - Country:US
Practice Address - Phone:216-255-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.143454164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse