Provider Demographics
NPI:1265047831
Name:BROWN, KIM (INDIVIDUAL PROVIDER)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:INDIVIDUAL PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 BENADUM RD
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:OH
Mailing Address - Zip Code:43112-9617
Mailing Address - Country:US
Mailing Address - Phone:805-407-4153
Mailing Address - Fax:
Practice Address - Street 1:8200 BENADUM RD
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:OH
Practice Address - Zip Code:43112-9617
Practice Address - Country:US
Practice Address - Phone:805-407-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide