Provider Demographics
NPI:1821140831
Name:CULLERS, KIMBER (NP)
Entity Type:Individual
Prefix:
First Name:KIMBER
Middle Name:
Last Name:CULLERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6716 BECKHOLT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-8157
Mailing Address - Country:US
Mailing Address - Phone:740-398-5575
Mailing Address - Fax:
Practice Address - Street 1:1490 COSHOCTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-6099
Practice Address - Country:US
Practice Address - Phone:740-393-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07103207P00000X
OHAPRN.CNP.07103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2742330Medicaid
OHP70214Medicare UPIN
OH2742330Medicaid