Provider Demographics
NPI:1790913184
Name:TODD, KIMBERLY JO (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:TODD
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 1:164 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5779
Mailing Address - Country:US
Mailing Address - Phone:740-876-4599
Mailing Address - Fax:
Practice Address - Street 1:164 WILSON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-5779
Practice Address - Country:US
Practice Address - Phone:740-876-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-099006164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse