Provider Demographics
NPI:1922314616
Name:SHEETS, KIMBERLY L (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:SHEETS
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 1:44 1/2 S BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1402
Mailing Address - Country:US
Mailing Address - Phone:585-610-8856
Mailing Address - Fax:
Practice Address - Street 1:4638 NOBLES RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NY
Practice Address - Zip Code:14813-9722
Practice Address - Country:US
Practice Address - Phone:585-268-7240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7186104164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse