Provider Demographics
NPI:1972805091
Name:DEBORD, KIMBERLY DANIELLE (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DANIELLE
Last Name:DEBORD
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 1:4175 SCHROEDER DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9012
Mailing Address - Country:US
Mailing Address - Phone:513-300-6452
Mailing Address - Fax:
Practice Address - Street 1:4175 SCHROEDER DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45011-9012
Practice Address - Country:US
Practice Address - Phone:513-300-6452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.135744-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse