Healthcare Provider Details

I. General information

NPI: 1154014256
Provider Name (Legal Business Name): MISS KIMBERLY ANN CORPENING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4259 W 121ST ST
CLEVELAND OH
44135-4703
US

IV. Provider business mailing address

4259 W 121ST ST
CLEVELAND OH
44135-4703
US

V. Phone/Fax

Practice location:
  • Phone: 216-374-1304
  • Fax:
Mailing address:
  • Phone: 216-374-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: