Healthcare Provider Details

I. General information

NPI: 1942570080
Provider Name (Legal Business Name): KIMBERLY M. KOPFMAN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY M. STONE CPNP

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 RIVERSIDE DRIVE, SUITE 200
UPPER ARLINGTON OH
43221-1738
US

IV. Provider business mailing address

3300 RIVERSIDE DRIVE, SUITE 200
UPPER ARLINGTON OH
43221-1738
US

V. Phone/Fax

Practice location:
  • Phone: 614-459-4200
  • Fax: 614-459-1589
Mailing address:
  • Phone: 614-459-4200
  • Fax: 614-459-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.5538
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.399668
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberALPP-3267
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCOA.18068-NP
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number10868-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: