Healthcare Provider Details

I. General information

NPI: 1043171036
Provider Name (Legal Business Name): KIMBERLY HENNINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 E MAIN ST STE 104
COLUMBUS OH
43213-2441
US

IV. Provider business mailing address

1026 PRESTIGE BLVD
LANCASTER OH
43130-7968
US

V. Phone/Fax

Practice location:
  • Phone: 614-604-8274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: