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NPI Code Detail

MEDICARE: KIMBERLY A JIVIDEN CNP

MEDICARE: KIMBERLY A JIVIDEN CNP
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
1363LF0000XFamily Nurse Practitioner58709WV
2163W00000XRegistered NurseRN298807OH
3363LF0000XFamily Nurse PractitionerCOA.16207-NPOH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01439933OTHEROHRAILROAD MEDICARE - MHCPI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205242369
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY A JIVIDEN CNP
Provider Business Mailing Address
First Line : PO BOX 609
Second Line :
City : ELIZABETH
State : WV
Zip : 26143-0609
Country : US
Telephone Number : 304-275-3301
Fax Number : 304-275-4798
Provider Business Practice Location Address
First Line : 483 COURT ST
Second Line :
City : ELIZABETH
State : WV
Zip : 26143-1109
Country : US
Telephone Number : 304-275-3301
Fax Number : 304-275-4798
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2014
Last Update Date : 05/01/2018

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Directions to “ KIMBERLY A JIVIDEN CNP” Practice Location

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