Provider Demographics
NPI:1902462054
Name:LETSON, KIMBERLY CARLENE (APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CARLENE
Last Name:LETSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4387 LEEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2520
Mailing Address - Country:US
Mailing Address - Phone:330-807-5421
Mailing Address - Fax:
Practice Address - Street 1:3562 RIDGE PARK DR STE D1
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9294
Practice Address - Country:US
Practice Address - Phone:330-664-1670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.313361163WE0003X
OHAPRN.CNP.024571208100000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation