NPIMap

Organization Active NPI

Kimberly L Tillman

  • Licensed Practical Nurse
  • Cleveland, OH
National Provider Identifier
1881000461
Registry record updated Jul 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
PN.143666M-IV Issued in OH
Legal business name
KIMBERLY L TILLMAN
Practice address
11410 Ashbury Ave
Cleveland, OH 44106-1310
Phone
(216) 246-8014
NPI assigned
Jul 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2014

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

Authorized official

Name
Kimberly L TillmanNPI 1679989172
Title
PN.M-IV
Phone
(216) 246-8014

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical NurseGroup: 193400000X SINGLE SPECIALTY GROUP 164W00000X PN.143666M-IV OH Primary

Addresses

Primary practice location

11410 Ashbury Ave
Cleveland, OH 44106-1310

Mailing address

11410 Ashbury Ave
Cleveland, OH 44106-1310
Phone (216) 246-8014

Other identifiers 1

IdentifierTypeStateIssuer
PN.143666-M-IVMedicaidOH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1404345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404345600000",
    "number": "1881000461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11410 ASHBURY AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061310",
            "telephone_number": "216-246-8014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11410 ASHBURY AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061310",
            "telephone_number": "216-246-8014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLY L TILLMAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-03",
        "last_updated": "2014-07-03",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PN.M-IV",
        "authorized_official_telephone_number": "216-246-8014"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "PN.143666M-IV",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PN.143666-M-IV",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2014; 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.