Healthcare Provider Details

I. General information

NPI: 1710531918
Provider Name (Legal Business Name): KIMBERLY KNORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 06/26/2023
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4384 RHODES AVE
NEW BOSTON OH
45662-1712
US

IV. Provider business mailing address

120 W MAIN
CIRCLEVILLE OH
43113
US

V. Phone/Fax

Practice location:
  • Phone: 740-566-5600
  • Fax:
Mailing address:
  • Phone: 740-357-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1903902
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: