Healthcare Provider Details

I. General information

NPI: 1356579114
Provider Name (Legal Business Name): KIMBERLY CHRISTINA THOMPSON STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 KIMBERLY PKWY E
COLUMBUS OH
43232-4271
US

IV. Provider business mailing address

825 E 5TH AVE
COLUMBUS OH
43201-2917
US

V. Phone/Fax

Practice location:
  • Phone: 614-868-9306
  • Fax:
Mailing address:
  • Phone: 614-516-1499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number377878531298
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: