Provider Demographics
NPI:1093695397
Name:COLE, KIMBERLY MARTIN (LPN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARTIN
Last Name:COLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830-3340
Mailing Address - Country:US
Mailing Address - Phone:607-316-7305
Mailing Address - Fax:
Practice Address - Street 1:159 BROWN RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NY
Practice Address - Zip Code:13830-3340
Practice Address - Country:US
Practice Address - Phone:607-316-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305207164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty