MEDICARE: RAVEN SEYMONE KIMBRO

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	251E00000X	Home Health Agency	402235311219	OH

General Provider Information

NPI Number	:	1942164694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN SEYMONE KIMBRO

Provider Business Mailing Address
First Line	:	2614 PIONEER TRL APT 609
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870-5188
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2614 PIONEER TRL APT 609
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870-5188
Country	:	US
Telephone Number	:	440-654-6528
Fax Number	:

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ RAVEN SEYMONE KIMBRO ” Practice Location

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