Individual
KIMBERLY A JIVIDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
483 COURT ST, ELIZABETH, WV 26143-1109
(304) 275-3301
(304) 275-4798
Mailing address
PO BOX 609, ELIZABETH, WV 26143-0609
(304) 275-3301
(304) 275-4798
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN298807
OH
363LF0000X
Family Nurse Practitioner
58709
WV
363LF0000X
Family Nurse Practitioner
Primary
COA.16207-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0107154
—
OH
05
—
1205242369
—
WV
05
—
3810029263
—
WV
01
—
P01439933
RAILROAD MEDICARE - MHCPI
OH
Enumeration date
07/09/2014
Last updated
05/01/2018
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