Basic Information
| Provider Information | |||||||||
| NPI: | 1659679868 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4449 STATE ROUTE 159 | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456018620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407727892 | ||||||||
| FaxNumber: | 7407731264 | ||||||||
| Practice Location | |||||||||
| Address1: | 312 E 2ND ST | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456012639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407751270 | ||||||||
| FaxNumber: | 7407731264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2011 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator | 164W00000X | PN075181 | OH | N | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.