Provider Demographics
NPI:1013188812
Name:REGIS, KIMBERLY R (CPNP)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:R
Last Name:REGIS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5980 CARNEGIE COVE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-5116
Mailing Address - Country:US
Mailing Address - Phone:614-360-7841
Mailing Address - Fax:
Practice Address - Street 1:700 CHILDRENS DR
Practice Address - Street 2:TIMKEN H235
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2664
Practice Address - Country:US
Practice Address - Phone:614-722-3565
Practice Address - Fax:614-722-3546
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 302122/NP. 08759363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner