Provider Demographics
NPI:1265707756
Name:ACKLEY, KIMBERLY JENELLE (APRN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JENELLE
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 BIRCHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-9773
Mailing Address - Country:US
Mailing Address - Phone:419-581-0538
Mailing Address - Fax:
Practice Address - Street 1:15100 BIRCHAVEN LN
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-9773
Practice Address - Country:US
Practice Address - Phone:419-425-3158
Practice Address - Fax:419-425-3805
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 357559163W00000X
OHAPRN.CNP.0026921363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse