Healthcare Provider Details

I. General information

NPI: 1174488043
Provider Name (Legal Business Name): KIMBERLY LENISE ABERNATHY CERTIFICATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 GLENCROSS AVE
CINCINNATI OH
45217-1912
US

IV. Provider business mailing address

4524 CENTREBROOK CIR
RALEIGH NC
27616-8420
US

V. Phone/Fax

Practice location:
  • Phone: 513-264-8134
  • Fax:
Mailing address:
  • Phone: 513-264-8134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: