Healthcare Provider Details

I. General information

NPI: 1972716827
Provider Name (Legal Business Name): KIMBERLY PERSON SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6703 ALANA PL
LIBERTY TWP OH
45011-0756
US

IV. Provider business mailing address

6703 ALANA PL
LIBERTY TWP OH
45011-0756
US

V. Phone/Fax

Practice location:
  • Phone: 513-895-3660
  • Fax:
Mailing address:
  • Phone: 513-895-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2112921
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: