Healthcare Provider Details

I. General information

NPI: 1114779246
Provider Name (Legal Business Name): KIMBERLY VERHOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3567 RESERVE COMMONS DR STE 100
MEDINA OH
44256-5344
US

IV. Provider business mailing address

7046 STATE ROUTE 12
COLUMBUS GROVE OH
45830-9605
US

V. Phone/Fax

Practice location:
  • Phone: 330-536-3746
  • Fax:
Mailing address:
  • Phone: 419-969-4788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN.478605
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: