Healthcare Provider Details

I. General information

NPI: 1548532518
Provider Name (Legal Business Name): KIMBERLY RUTH MASTERS RN, CWCN, COCN,CCCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR # 118
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

1101 VETERANS DR # 118
LEXINGTON KY
40502-2235
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax:
Mailing address:
  • Phone: 859-233-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License Number1060942
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number1060942
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number1060942
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: