Provider Demographics
NPI:1780842500
Name:WOODFORD, KIMBERLY A (RN)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:WOODFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7460 ELSON ST SE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44688-9508
Mailing Address - Country:US
Mailing Address - Phone:330-842-9162
Mailing Address - Fax:
Practice Address - Street 1:7460 ELSON ST SE
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:OH
Practice Address - Zip Code:44688-9508
Practice Address - Country:US
Practice Address - Phone:330-842-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.394630163WH1000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH1000XNursing Service ProvidersRegistered NurseHospice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2726803Medicaid