Provider Demographics
NPI:1871831016
Name:BENJAMIN, KIMBERLY A (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:PLAISTED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2570 SPAULDING DR
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-3518
Mailing Address - Country:US
Mailing Address - Phone:607-654-0205
Mailing Address - Fax:607-962-5390
Practice Address - Street 1:319 W WATER ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2914
Practice Address - Country:US
Practice Address - Phone:607-734-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234429-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse