Healthcare Provider Details

I. General information

NPI: 1821140831
Provider Name (Legal Business Name): KIMBER CULLERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 COSHOCTON AVE
MOUNT VERNON OH
43050-6099
US

IV. Provider business mailing address

6716 BECKHOLT RD
MOUNT VERNON OH
43050-8157
US

V. Phone/Fax

Practice location:
  • Phone: 740-393-9111
  • Fax:
Mailing address:
  • Phone: 740-398-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberNP07103
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.07103
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: