Provider Demographics
NPI:1750403796
Name:BARAJAS, KIMBERLY L (LPN)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:L
Last Name:BARAJAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5686 SNOW DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8392
Mailing Address - Country:US
Mailing Address - Phone:614-219-2123
Mailing Address - Fax:
Practice Address - Street 1:5686 SNOW DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-8392
Practice Address - Country:US
Practice Address - Phone:614-219-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-090542164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN-090542OtherNURSING LICENSE