Healthcare Provider Details

I. General information

NPI: 1023815883
Provider Name (Legal Business Name): TEARA KIMBLE-JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5177 CAMDEN RD
MAPLE HEIGHTS OH
44137-2256
US

IV. Provider business mailing address

5177 CAMDEN RD
MAPLE HEIGHTS OH
44137-2256
US

V. Phone/Fax

Practice location:
  • Phone: 216-331-8100
  • Fax:
Mailing address:
  • Phone: 216-331-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number347C00000X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: