Provider Demographics
NPI:1134368780
Name:MOELLER, KIMBERLY J (CNS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:MOELLER
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:PO BOX 2090
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-996-8603
Mailing Address - Fax:330-996-8695
Practice Address - Street 1:161 N FORGE ST
Practice Address - Street 2:STE. 198
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1468
Practice Address - Country:US
Practice Address - Phone:330-376-1043
Practice Address - Fax:330-376-9951
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS10499364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2986112Medicaid
OHNS04311Medicare PIN