Provider Demographics
NPI:1851909949
Name:NEWTON, KIMBERELY T (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBERELY
Middle Name:T
Last Name:NEWTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KIMBERELY
Other - Middle Name:T
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1426 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-1308
Mailing Address - Country:US
Mailing Address - Phone:216-877-6377
Mailing Address - Fax:
Practice Address - Street 1:1426 E 55TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-1308
Practice Address - Country:US
Practice Address - Phone:216-877-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161511-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse