Kimberly Sue Russell, NURSE/LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN109782 Issued in OH

Practice address

81 Rhoads Center Dr
Centerville, OH 45458-3859

Phone

(937) 435-1161

NPI assigned

Apr 27, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Ms. Kimberly Sue Russell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1240790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240790400000",
    "number": "1780828343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1453 COMMONWEALTH DR",
            "city": "XENIA",
            "state": "OH",
            "postal_code": "453854801",
            "telephone_number": "937-239-0663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 RHOADS CENTER DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454583859",
            "telephone_number": "937-435-1161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KIMBERLY",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "NURSE/LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-27",
        "last_updated": "2009-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "PN109782",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "109782",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2586867",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "RUSSELL",
            "middle_name": "SUE",
            "prefix": "MS.",
            "credential": "NURSE/LPN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Olivia Ruckman, PT
• James Ruehle, MD
• Melinda Lee Ruff, MD
• Luis Ruiz
• Barry Rush
• Michelle M Russell, DO
• Joel Russo, AT, ATC
• Sabiha T. Siddiqui, LLC
• Patrick Sabol
• Caileigh Sailers, LSW

• Licensed Practical Nurse in Centerville, OH
• Providers in Centerville, 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 Apr 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.