Healthcare Provider Details

I. General information

NPI: 1649314170
Provider Name (Legal Business Name): KIMBERLY EBERST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CRAMER CREEK CT.
DUBLIN OH
43017
US

IV. Provider business mailing address

3689 WATT RD
GAHANNA OH
43230-1158
US

V. Phone/Fax

Practice location:
  • Phone: 614-889-5722
  • Fax: 614-889-9335
Mailing address:
  • Phone: 614-507-2622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: