Healthcare Provider Details

I. General information

NPI: 1386588846
Provider Name (Legal Business Name): KIMBERLY DENISE HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 FAIRMOUNT AVE
CINCINNATI OH
45214-1224
US

IV. Provider business mailing address

3433 BLUE ROCK RD
CINCINNATI OH
45239-5103
US

V. Phone/Fax

Practice location:
  • Phone: 513-480-9200
  • Fax: 513-480-9200
Mailing address:
  • Phone: 513-480-9200
  • Fax: 513-480-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: