Basic Information
| Provider Information | |||||||||
| NPI: | 1134368780 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOELLER | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | C.N.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 E MARKET ST | ||||||||
| Address2: | PO BOX 2090 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309968603 | ||||||||
| FaxNumber: | 3309968695 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 N FORGE ST | ||||||||
| Address2: | STE. 198 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303761043 | ||||||||
| FaxNumber: | 3303769951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2009 | ||||||||
| LastUpdateDate: | 03/23/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364S00000X | NS10499 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2986112 | 05 | OH | MEDICAID |