Provider Demographics
NPI:1871348896
Name:BARNETT, KIM MARIE
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:BARNETT
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 1:738 CLARENDON RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1114
Mailing Address - Country:US
Mailing Address - Phone:937-641-1294
Mailing Address - Fax:
Practice Address - Street 1:738 CLARENDON RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1114
Practice Address - Country:US
Practice Address - Phone:937-641-1294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRQ190633347C00000X, 253Z00000X, 347E00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle
No253Z00000XAgenciesIn Home Supportive Care
No347E00000XTransportation ServicesTransportation Broker