Provider Demographics
NPI:1811402886
Name:MYERS, KIMBERLY MICHELLE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:MYERS
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 1:31144 MCKAIG RD
Mailing Address - Street 2:
Mailing Address - City:HANOVERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44423-9785
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31144 MCKAIG RD
Practice Address - Street 2:
Practice Address - City:HANOVERTON
Practice Address - State:OH
Practice Address - Zip Code:44423
Practice Address - Country:US
Practice Address - Phone:330-223-2145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF03170613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily