Provider Demographics
NPI:1972628022
Name:VALENTINE, KIMBERLY (LPN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:VALENTINE
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 1:913 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-1817
Mailing Address - Country:US
Mailing Address - Phone:740-439-0142
Mailing Address - Fax:
Practice Address - Street 1:318 N 9TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-1804
Practice Address - Country:US
Practice Address - Phone:740-432-7198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN077334164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2190249OtherIP NUMBER