Provider Demographics
NPI:1073349213
Name:KIMBERLING, LISA ANN (LPN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:KIMBERLING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 TERRIER CT
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-9797
Mailing Address - Country:US
Mailing Address - Phone:614-421-8338
Mailing Address - Fax:
Practice Address - Street 1:148 TERRIER CT
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-9797
Practice Address - Country:US
Practice Address - Phone:614-421-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH181464164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse