Provider Demographics
NPI:1902850217
Name:TRIPLETT, KIMBERLY DAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DAWN
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:LAUDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4150
Practice Address - Street 1:2900 1ST AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1241
Practice Address - Country:US
Practice Address - Phone:304-526-1436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1686207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001468773OtherBLUE CROSS BLUE SHIELD
OH2154716Medicaid
WV1053041OtherWORKERS COMPENSATION
OH2154718Medicaid
WV3810005500Medicaid
WVH13733Medicare UPIN
WVLA4016978Medicare PIN
WV1053041OtherWORKERS COMPENSATION