Healthcare Provider Details

I. General information

NPI: 1104408814
Provider Name (Legal Business Name): KIMBERLY ALLEN-DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2686 BLOOM DR
COLUMBUS OH
43219-5539
US

IV. Provider business mailing address

2686 BLOOM DR
COLUMBUS OH
43219-5539
US

V. Phone/Fax

Practice location:
  • Phone: 614-783-4399
  • Fax:
Mailing address:
  • Phone: 614-783-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: