Provider Demographics
NPI:1801508833
Name:RHODES, KIMBERLY DAWN (LPN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:RHODES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5414 BALLARD RED SULPHUR PKWY
Mailing Address - Street 2:
Mailing Address - City:PETERSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:24963-6048
Mailing Address - Country:US
Mailing Address - Phone:304-793-2628
Mailing Address - Fax:304-936-0155
Practice Address - Street 1:5414 BALLARD RED SULPHUR PKWY
Practice Address - Street 2:
Practice Address - City:PETERSTOWN
Practice Address - State:WV
Practice Address - Zip Code:24963-6048
Practice Address - Country:US
Practice Address - Phone:304-793-2628
Practice Address - Fax:304-936-0155
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24416164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse