Provider Demographics
NPI:1730902859
Name:KIMBROUGH, MARCIA
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:KIMBROUGH
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 1:5939 MARRA DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3024
Mailing Address - Country:US
Mailing Address - Phone:216-403-9619
Mailing Address - Fax:
Practice Address - Street 1:5939 MARRA DR
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-3024
Practice Address - Country:US
Practice Address - Phone:216-403-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula