Provider Demographics
NPI:1548695844
Name:MANN, KIMBERLY (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:304-781-5159
Mailing Address - Fax:304-523-8115
Practice Address - Street 1:220 JOHNS CREEK ROAD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-1513
Practice Address - Country:US
Practice Address - Phone:304-743-1407
Practice Address - Fax:304-743-4516
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV72536363LF0000X
WVAPRN72536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1548695844Medicaid
OH0097522Medicaid
KY7100294060Medicaid