Provider Demographics
NPI:1457376550
Name:COLEGATE, KIMBERLY D (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:D
Last Name:COLEGATE
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8778 CABOT DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4533
Mailing Address - Country:US
Mailing Address - Phone:513-521-0633
Mailing Address - Fax:513-521-0351
Practice Address - Street 1:8778 CABOT DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4533
Practice Address - Country:US
Practice Address - Phone:513-521-0633
Practice Address - Fax:513-521-0351
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2112547OtherINDEPENDENTPROVIDERNUMBER