MEDICARE: MISS KIMBERLY ANN CORPENING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TA0700X	Adult Development & Aging Psychologist
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1154014256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KIMBERLY ANN CORPENING

Provider Business Mailing Address
First Line	:	4259 W 121ST ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-4703
Country	:	US
Telephone Number	:	216-374-1304
Fax Number	:

Provider Business Practice Location Address
First Line	:	4259 W 121ST ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-4703
Country	:	US
Telephone Number	:	216-374-1304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/06/2023

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Directions to “ MISS KIMBERLY ANN CORPENING ” Practice Location

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