Kimberly Jean Detlef, L.P.N

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN 086382 Issued in OH

Practice address

624 Berry St
Toledo, OH 43605-2621

Phone

(419) 810-7796

NPI assigned

Feb 27, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Kimberly Jean Detlef Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204243200000",
    "number": "1225004328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 BERRY ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436052621",
            "telephone_number": "419-810-7796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 BERRY ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436052621",
            "telephone_number": "419-810-7796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETLEF",
        "first_name": "KIMBERLY",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "L.P.N",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-27",
        "last_updated": "2008-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "PN 086382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "DETLEF",
            "middle_name": "JEAN",
            "prefix": "MS.",
            "credential": "L.P.N.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Licensed Practical Nurse in Toledo, OH
• Providers in Toledo, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.