Provider Demographics
NPI:1013953637
Name:BRUMFIELD, KIMBERLEY ANN (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANN
Last Name:BRUMFIELD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:A
Other - Last Name:TOLLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1460 LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-7900
Mailing Address - Country:US
Mailing Address - Phone:937-232-8033
Mailing Address - Fax:937-426-6576
Practice Address - Street 1:1460 LUDLOW RD
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-7900
Practice Address - Country:US
Practice Address - Phone:937-232-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4699P207Q00000X
OHNP05237207Q00000X
OH05237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11480492OtherCAQH
KY7100014770Medicaid
OH2180885Medicaid
OH2180885Medicaid
OHH277440Medicare PIN
OHNP04214Medicare PIN
OH11480492OtherCAQH
OHNP04213Medicare PIN
KY0586643Medicare PIN
KY0264275Medicare PIN
OHNP04215Medicare PIN
KY0307670Medicare PIN
KY3400352Medicare PIN
KY0632966Medicare PIN