Provider Demographics
NPI:1972297182
Name:ROBINSON-HERRIOTT, KIMBERLY LAVETTE
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LAVETTE
Last Name:ROBINSON-HERRIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5785 EMPIRE MILLS RUN
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8027
Mailing Address - Country:US
Mailing Address - Phone:614-515-0089
Mailing Address - Fax:
Practice Address - Street 1:5785 EMPIRE MILLS RUN
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8027
Practice Address - Country:US
Practice Address - Phone:614-515-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility