Provider Demographics
NPI:1023815883
Name:KIMBLE-JONES, TEARA
Entity type:Individual
Prefix:
First Name:TEARA
Middle Name:
Last Name:KIMBLE-JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5177 CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2256
Mailing Address - Country:US
Mailing Address - Phone:216-331-8100
Mailing Address - Fax:
Practice Address - Street 1:5177 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2256
Practice Address - Country:US
Practice Address - Phone:216-331-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH347C00000X171WV0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications