Healthcare Provider Details

I. General information

NPI: 1689587917
Provider Name (Legal Business Name): KIM HAMMONS RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4313 BLUEBIRD DR
POWELL OH
43065-1663
US

IV. Provider business mailing address

4313 BLUEBIRD DR
POWELL OH
43065-1663
US

V. Phone/Fax

Practice location:
  • Phone: 740-262-7137
  • Fax:
Mailing address:
  • Phone: 740-262-7137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-319927
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: