Provider Demographics
NPI:1699313502
Name:FOX, KIMBERLY CLARE (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CLARE
Last Name:FOX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3651
Mailing Address - Country:US
Mailing Address - Phone:585-966-4905
Mailing Address - Fax:
Practice Address - Street 1:300 HOLMES RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3651
Practice Address - Country:US
Practice Address - Phone:585-966-4905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY643808163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse