Healthcare Provider Details

I. General information

NPI: 1275260929
Provider Name (Legal Business Name): KIMBERLY SPIRES LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 GRANT ST
PORTSMOUTH OH
45662-3663
US

IV. Provider business mailing address

1616 GRANT ST
PORTSMOUTH OH
45662-3663
US

V. Phone/Fax

Practice location:
  • Phone: 740-981-6758
  • Fax:
Mailing address:
  • Phone: 740-901-0416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.172954.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: