Individual
KIMBERLY DEMATTIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP, LSW
Contact information
Practice address
205 MARION PIKE, COAL GROVE, OH 45638-3165
(740) 532-1188
Mailing address
PO BOX 1680, HUNTINGTON, WV 25717-1680
(304) 781-5151
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
S.0028154
OH
163W00000X
Registered Nurse
RN.444863
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN.CNP.0026784
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0405888
—
OH
05
—
7100763640
—
KY
Enumeration date
11/08/2017
Last updated
08/29/2024
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