MEDICARE: KIMBERLY KAY HARTER

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	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8100763	OTHER	OH	DODD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588261275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY KAY HARTER

Provider Business Mailing Address
First Line	:	16986 BURRIS RD
Second Line	:
City	:	OHIO CITY
State	:	OH
Zip	:	45874-9734
Country	:	US
Telephone Number	:	419-203-7712
Fax Number	:

Provider Business Practice Location Address
First Line	:	16986 BURRIS RD
Second Line	:
City	:	OHIO CITY
State	:	OH
Zip	:	45874-9734
Country	:	US
Telephone Number	:	419-203-7712
Fax Number	:

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

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	10/06/2020

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Directions to “ KIMBERLY KAY HARTER ” Practice Location

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