Healthcare Provider Details

I. General information

NPI: 1760343164
Provider Name (Legal Business Name): KIMBERLY SUE BUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15655 STATE ROUTE 170
EAST LIVERPOOL OH
43920-9069
US

IV. Provider business mailing address

12516 STATE ROUTE 534
SALEM OH
44460-9131
US

V. Phone/Fax

Practice location:
  • Phone: 330-386-4303
  • Fax:
Mailing address:
  • Phone: 216-272-9448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN290366
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: