Provider Demographics
NPI:1255103438
Name:THATCHER, KIMBERLY KRISTEEN
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KRISTEEN
Last Name:THATCHER
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 1:608 ULMS DR LOT 19
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-9500
Mailing Address - Country:US
Mailing Address - Phone:141-977-1676
Mailing Address - Fax:
Practice Address - Street 1:608 ULMS DR LOT 19
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-9500
Practice Address - Country:US
Practice Address - Phone:419-771-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health