MEDICARE: MRS. KIMBERLY SUE FUSSNECKER

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
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1396404109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY SUE FUSSNECKER

Provider Business Mailing Address
First Line	:	8134 FROST RD
Second Line	:
City	:	RUSSELLVILLE
State	:	OH
Zip	:	45168-9787
Country	:	US
Telephone Number	:	937-515-0939
Fax Number	:

Provider Business Practice Location Address
First Line	:	8134 FROST RD
Second Line	:
City	:	RUSSELLVILLE
State	:	OH
Zip	:	45168-9787
Country	:	US
Telephone Number	:	937-515-0939
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2021
Last Update Date	:	12/28/2021

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