Active NPI
Kimberly Renee Michael
- Licensed Practical Nurse
- Marietta, OH
National Provider Identifier
1194803304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN -110700
- Practice address
- 650 Cole Coffman Rd
Marietta, OH 45750-6784 - Phone
- (740) 525-4034
- NPI assigned
- Nov 2, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN -110700 | OH | Primary |
Addresses
Primary practice location
650 Cole Coffman Rd
Marietta, OH 45750-6784
Mailing address
650 Cole Coffman Rd
Marietta, OH 45750-6784
Phone (740) 525-4034
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2543395 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN -110700 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457395200000",
"number": "1194803304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 COLE COFFMAN RD",
"city": "MARIETTA",
"state": "OH",
"postal_code": "457506784",
"telephone_number": "740-525-4034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 COLE COFFMAN RD",
"city": "MARIETTA",
"state": "OH",
"postal_code": "457506784",
"telephone_number": "740-525-4034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICHAEL",
"first_name": "KIMBERLY",
"middle_name": "RENEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-02",
"last_updated": "2016-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "PN -110700",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2543395",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marietta, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.