Provider Demographics
NPI:1548532518
Name:MASTERS, KIMBERLY RUTH (RN, CWCN, COCN,CCCN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RUTH
Last Name:MASTERS
Suffix:
Gender:F
Credentials:RN, CWCN, COCN,CCCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 VETERANS DR # 118
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2235
Mailing Address - Country:US
Mailing Address - Phone:859-233-4511
Mailing Address - Fax:
Practice Address - Street 1:1101 VETERANS DR # 118
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2235
Practice Address - Country:US
Practice Address - Phone:859-233-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1060942163WE0900X, 163WW0000X, 163WX1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care