Healthcare Provider Details

I. General information

NPI: 1003669672
Provider Name (Legal Business Name): KIMBERLY NOCK APRN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 07/07/2024
Certification Date: 07/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ADELBERT RD
CLEVELAND OH
44106-2624
US

IV. Provider business mailing address

6102 HERBERT RD
CANFIELD OH
44406-9779
US

V. Phone/Fax

Practice location:
  • Phone: 234-855-3628
  • Fax:
Mailing address:
  • Phone: 234-855-3628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPRN.CNP.0036929
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN.419933
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: