Provider Demographics
NPI:1801428404
Name:APPLEGATE, KIMBERLY SUZETTE (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUZETTE
Last Name:APPLEGATE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 LITHOPOLIS RD NW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9513
Mailing Address - Country:US
Mailing Address - Phone:740-438-2334
Mailing Address - Fax:
Practice Address - Street 1:2231 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-1194
Practice Address - Country:US
Practice Address - Phone:614-404-8417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2021-03-11
Deactivation Date:2020-02-14
Deactivation Code:
Reactivation Date:2021-03-11
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024919363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily