MEDICARE: KIMBERLY HELEN BENNIE

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	3125064	OH

General Provider Information

NPI Number	:	1417684879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY HELEN BENNIE

Provider Business Mailing Address
First Line	:	1512 THOMASTON DR APT B
Second Line	:
City	:	AMELIA
State	:	OH
Zip	:	45102-1082
Country	:	US
Telephone Number	:	513-981-1247
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 THOMASTON DR APT B
Second Line	:
City	:	AMELIA
State	:	OH
Zip	:	45102-1082
Country	:	US
Telephone Number	:	513-981-1247
Fax Number	:

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

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	08/05/2022

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Directions to “ KIMBERLY HELEN BENNIE ” Practice Location

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