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NPI Code Detail

MEDICARE: MRS. KIMBERLY D JARVIS QHMS

MEDICARE: MRS. KIMBERLY D JARVIS QHMS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1366170946
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY D JARVIS QHMS
Provider Business Mailing Address
First Line : 51 BEST ST
Second Line :
City : DAYTON
State : OH
Zip : 45405-4906
Country : US
Telephone Number : 937-673-6988
Fax Number : 937-223-8638
Provider Business Practice Location Address
First Line : 51 BEST ST
Second Line :
City : DAYTON
State : OH
Zip : 45405-4906
Country : US
Telephone Number : 937-673-6988
Fax Number : 937-673-6988
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2022
Last Update Date : 09/26/2022

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