MEDICARE: KIMBERLY JEAN SMITH

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	3747P1801X	Personal Care Attendant		OH

General Provider Information

NPI Number	:	1871368910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY JEAN SMITH

Provider Business Mailing Address
First Line	:	3892 PERT HILL RD
Second Line	:
City	:	HOPEWELL
State	:	OH
Zip	:	43746-9762
Country	:	US
Telephone Number	:	740-624-9376
Fax Number	:

Provider Business Practice Location Address
First Line	:	3892 PERT HILL RD
Second Line	:
City	:	HOPEWELL
State	:	OH
Zip	:	43746-9762
Country	:	US
Telephone Number	:	740-624-9376
Fax Number	:

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

Provider Enumeration Date	:	11/20/2023
Last Update Date	:	11/20/2023

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Directions to “ KIMBERLY JEAN SMITH ” Practice Location

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