Healthcare Provider Details

I. General information

NPI: 1093833287
Provider Name (Legal Business Name): KIMBERLY LOUISE HEARST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 HUNTRIDGE AVE
CINCINNATI OH
45231-4420
US

IV. Provider business mailing address

7410 HUNTRIDGE AVE
CINCINNATI OH
45231-4420
US

V. Phone/Fax

Practice location:
  • Phone: 513-903-9448
  • Fax:
Mailing address:
  • Phone: 513-903-9448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-353518
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN-353518
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: