Provider Demographics
NPI:1780194399
Name:MCCLURE, KIMBERLY S (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:MCCLURE
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 1:516 E CHILLICOTHE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1910
Mailing Address - Country:US
Mailing Address - Phone:937-869-4518
Mailing Address - Fax:
Practice Address - Street 1:516 E CHILLICOTHE AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1910
Practice Address - Country:US
Practice Address - Phone:937-869-4518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.134216.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLPN.134216.MEDS-IVOtherOHIO BOARD OF NURSING