MEDICARE: KIMBERLY A. MCKINLEY

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.170432	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.166917	OH
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCII.161730	OH
4	104100000X	Social Worker	S.2310011	OH
5	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCIII.162563	OH

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

NPI Number	:	1487135323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY A. MCKINLEY

Provider Business Mailing Address
First Line	:	6460 HARRISON AVE STE 200
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7958
Country	:	US
Telephone Number	:	513-941-4999
Fax Number	:	513-694-0168

Provider Business Practice Location Address
First Line	:	1421 PARKER CT
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-2855
Country	:	US
Telephone Number	:	513-941-4999
Fax Number	:	513-694-0168

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

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	12/05/2024

2101 E JEFFERSON ST , KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 701-922-1000
Practice Fax: 703-922-1039