1043282650 NPI number — MRS. KIMBERLY ANNE KARP RD, LD, CDE

Table of content: MRS. KIMBERLY ANNE KARP RD, LD, CDE (NPI 1043282650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043282650 NPI number — MRS. KIMBERLY ANNE KARP RD, LD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARP
Provider First Name:
KIMBERLY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LD, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCILVEEN
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043282650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GEMCARE WELLNESS
Provider Second Line Business Mailing Address:
5640 HUDSON INDUSTRIAL PKWY
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-331-9509
Provider Business Mailing Address Fax Number:
330-331-9509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GEMCARE WELLNESS
Provider Second Line Business Practice Location Address:
5640 HUDSON INDUSTRIAL PKWY
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-331-9509
Provider Business Practice Location Address Fax Number:
330-331-9509
Provider Enumeration Date:
02/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  LD-5728 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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