Provider Demographics
NPI:1548154115
Name:CLARK, KIMBERLY L
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 MAYHAM RD NE
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-9130
Mailing Address - Country:US
Mailing Address - Phone:330-418-8794
Mailing Address - Fax:330-418-8794
Practice Address - Street 1:4141 MAYHAM RD NE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-9130
Practice Address - Country:US
Practice Address - Phone:330-418-8794
Practice Address - Fax:330-418-8794
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)