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NPI Code Detail

MEDICARE: KIMBERLY LYNETTE GLENN CNP

MEDICARE: KIMBERLY LYNETTE GLENN CNP
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
1363LF0000XFamily Nurse PractitionerAPRN.CNP.18224OH

Other Identifiers

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

General Provider Information

NPI Number : 1992176606
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY LYNETTE GLENN CNP
Provider Business Mailing Address
First Line : 855 COSHOCTON AVE STE H
Second Line :
City : MOUNT VERNON
State : OH
Zip : 43050-1975
Country : US
Telephone Number : 740-224-3922
Fax Number :
Provider Business Practice Location Address
First Line : 855 COSHOCTON AVE STE H
Second Line :
City : MOUNT VERNON
State : OH
Zip : 43050-1975
Country : US
Telephone Number : 740-224-3922
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2015
Last Update Date : 07/14/2021

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Directions to “ KIMBERLY LYNETTE GLENN CNP” Practice Location

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