Provider Demographics
NPI:1992957831
Name:ROGERS, KIMBERLY LYNETTE (LPN)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:LYNETTE
Last Name:ROGERS
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 1:13074 CEDAR RD.
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44118
Mailing Address - Country:US
Mailing Address - Phone:216-321-9110
Mailing Address - Fax:
Practice Address - Street 1:13074 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2752
Practice Address - Country:US
Practice Address - Phone:216-321-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH121675164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse