MEDICARE: KIMBERLY FAGG

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	376K00000X	Nurse's Aide	321472850824	OH

General Provider Information

NPI Number	:	1902633811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY FAGG

Provider Business Mailing Address
First Line	:	4118 N LOCKWOOD AVE APT 2
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1745
Country	:	US
Telephone Number	:	812-870-7527
Fax Number	:

Provider Business Practice Location Address
First Line	:	4118 N LOCKWOOD AVE # 2
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1745
Country	:	US
Telephone Number	:	812-870-7527
Fax Number	:

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

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	09/16/2024

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Directions to “ KIMBERLY FAGG ” Practice Location

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