Provider Demographics
NPI:1063087054
Name:DONNELLY, KIMBERLEY DOROTHEA (FNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:DOROTHEA
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-3264
Mailing Address - Country:US
Mailing Address - Phone:740-381-4296
Mailing Address - Fax:
Practice Address - Street 1:500 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-3264
Practice Address - Country:US
Practice Address - Phone:740-381-4296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV108776363LF0000X
OHAPRN.CNP.0028589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily