MEDICARE: KIMBERLY PARIDON

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1730965435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY PARIDON

Provider Business Mailing Address
First Line	:	314 ADELAIDE AVE SE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-6112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 ADELAIDE AVE SE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-6112
Country	:	US
Telephone Number	:	234-830-8808
Fax Number	:

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

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	09/07/2023

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Directions to “ KIMBERLY PARIDON ” Practice Location

Language	Start Address	Practice Location

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