Provider Demographics
NPI:1336611508
Name:DULANEY, KIMBERLY DAWN
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:DULANEY
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 1:1488 S RIVERSIDE DR NW
Mailing Address - Street 2:
Mailing Address - City:MCCONNELSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43756-9635
Mailing Address - Country:US
Mailing Address - Phone:740-651-8856
Mailing Address - Fax:
Practice Address - Street 1:1488 S RIVERSIDE DR NW
Practice Address - Street 2:
Practice Address - City:MCCONNELSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43756-9635
Practice Address - Country:US
Practice Address - Phone:740-651-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN291883163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN29188OtherOHIO RN LICENSE