Provider Demographics
NPI:1801169859
Name:ALLIS, KIMBERLY GALE (LPN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:GALE
Last Name:ALLIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:GALE
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:7835 MYERS RD.
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-1127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7835 MYERS RD.
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-1127
Practice Address - Country:US
Practice Address - Phone:513-571-6132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.122059IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse