Provider Demographics
NPI:1689554826
Name:DAVID, KIMBERLY KAY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:DAVID
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 1:117 SPEARHEAD DR LOT 494
Mailing Address - Street 2:
Mailing Address - City:LAKE WAYNOKA
Mailing Address - State:OH
Mailing Address - Zip Code:45171-9231
Mailing Address - Country:US
Mailing Address - Phone:513-302-2914
Mailing Address - Fax:
Practice Address - Street 1:117 SPEARHEAD DR LOT 494
Practice Address - Street 2:
Practice Address - City:LAKE WAYNOKA
Practice Address - State:OH
Practice Address - Zip Code:45171-9231
Practice Address - Country:US
Practice Address - Phone:513-302-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty